I finished my last "training/orientation" shift this last Friday at ECMC. It was a busy 10 hour day. Officially, today is my start day, but somehow I managed to not be added to the schedule until Wednesday. So, along with my two day weekend, I have an additional two days to do more personal things: like unpack and finally stop living in the sea of boxes that has been my existence for the last 2 weeks.
I had several interesting patients on Friday. One was an example of how a patient can be in the ED all day. I first saw her at 08:30 and FINALLY discharged her at 18:45 (that's 6:45 p.m. in military time; for some reason, it's also the language of doctors, along with the metric system, but don't get me started... ) Anyway, when I first saw her, I thought she should have several film studies along with her blood work. My attending disagreed. Several hours later, after I had asked to give the patient another liter of fluid since she was so dehydrated, the attending went to see the patient and came out to tell me they agreed with my initial assessment, and that I should order some films. The films showed some concern for bowel inflammation, so a CT scan was in order. You have to drink contrast material to make an accurate diagnosis, and you can't have the CT scan until at least 40 minutes have passed to allow the contrast time to go through. So you can see the additional length of time. She was very polite about it, mostly I think because she said I was the nicest person she had ever encountered in the ED before. Well, that's a given.. :D
The rest of my patients were a motley mix of: a schizophrenic patient who had started walking into walls, a patient whose heart started beating in the 140's for no apparent reason, a patient who fell down the stairs and broke her foot (my first splint), a patient with shortness of breath most likely from the "holes in my heart," and my first "trauma" a heroin addict "my last hit was 4 hours ago but I only drank one beer" who was hit by a car. What you need to know is that drugs like heroin bind to the same pain receptors as morphine. But, the high is SO MUCH more intense. So much so that you actually, what I call, fry out the synapses. So you need to give these patients HUGE amounts of narcotics to help keep their pain under control. They get mad and belligerent at you because they're in pain, but then they're the ones who fried out their nerve endings. So it goes...
Finally, I had my last patient that I picked up in the final hour of my shift. I figured he wasn't going to take long, as his complaint on the board was "sore throat." What he didn't tell me was that he was being worked up for stomach cancer. And, his sore throat wasn't really sore throat but difficulty swallowing because food was taking a long time to go down. Of course. He has a big cancer blocking the entrance to his stomach, and food goes down slower as the passageway gets blocked. All he wanted was some relief so he could enjoy eating something of substance, but even now he is barely able to swallow soup.
This is the frustration. That of a complete inability to help someone despite everything. I could do nothing for this 70-something gentleman who was so calm and gentle in his demeanor. I know he was sitting out in the waiting room for hours; waiting his turn. He didn't have an urgent complaint. All my other patients definitely were more urgent than him, but I could almost see him sitting in chairs, smiling politely as other patients were called into the ED, and hours later finally getting his turn, only for me to tell him, "I'm sorry, there really isn't anything I can do."
I didn't say that, of course. Having been in surgery and having had an aunt who died of esophageal cancer, I knew what could be done for him. The offer of a surgery to remove part of his stomach and esophagus and create a new path for food. But, he is 70 and the complication rate is high. He's already lost 30 pounds in 6 months. He might be offered a feeding tube to bypass his stomach and give him some nutrition. But, I more than most understand his complaint. I enjoy food and can't imagine what it would be like to suddenly not be able to even enjoy something simple like soup. Imagine a world with no more ribeyes!
But I digress. His records showed pathology for a serious kind of stomach cancer. Recent workup showed that it hadn't spread, but still. There was nothing I could do for this gentle man. I talked to my attending and informed him of the situation. Theyrecommended some blood work to check the patient's level of hydration. It was the end of my shift, and I signed him out to the oncoming resident. But, before I left, I brought my patient a cold apple juice. At least he could have one small pleasure as he waited for the results, and for the inevitable, "There's nothing else we can do right now."