Being in the ED is kinda like being in Vegas. There are no windows, few clocks, and it can be any time of day or night, you'd never know. I never thought about it until last night when I was examining a patient. When I came into work it was a very warm, sunny evening. This man was wearing a jacket.
Ok. I asked him to remove it so I could examine him. His shirt was wet. He had come in because he was short of breath. I asked if he was having a really hard time breathing and he said no. I asked if he was having any chest pain. Again, no. I said, "Your shirt is all wet." He looked at me as if I was the stupidest person in the world and said, "Yeah, it's raining like crazy out there."
If you've ever watched "ER" the pilot episode is kinda like that. Various characters at one point or another come to the ambulance doors or a window and ask, "When did it start (raining, snowing), etc...?" Seriously, we're in an isolated environment. The only acknowledgement of the passage of time is the changing roster of patients on the Big White Board.
Some thoughts on last night:
- there's a disease called Pica. It's when you eat unusual things. I had a patient who was attempting to kill himself by indirectly causing harm to himself. He took a boatload of cocaine to give himself a heart attack. All he managed to do was ruin his heart valve requiring surgery. He's swallowed razor blades, and other objects to cause blockages and infections. Last night he came in because he'd swallowed a toothbrush ten days prior. CT scan found it still lodged in his stomach. The tube of toothpaste had already passed through. Seriously. He's going to be scoped by the GI doctors. No blockage. One day out of prison. Try again.
- A mother was concerned because she came home and found her son asleep on the couch. Couldn't wake him up so she called 911. On the way to the hospital, he admitted to using a large amount of cocaine. He was having chest pain and having trouble breathing. Then he passed out again. When I talked to his mother she didn't seem very concerned. "He's been drinking with his friends for the last 2 days and hasn't slept. He's just sleepy. By the way, he's had like a cold. His nose is all runny. Can you check him out for that too?" When the 19 year old finally came to about 6 hours later, he admitted to me about the cocaine and heavy alcohol use. Sorry, mom, the sniffles is from the snorting. Stop the coke and that will all go away. Oh yeah, and he wasn't sleeping because he was on a high. But, I didn't say that. Mom doesn't know about the drugs, and I was not going to be the one to tell her. I did my duty and told the son about the dangers of cocaine use. We'll see.
- if you're going to get drunk, pass out at home, not in the middle of street. People are going to want to stop and help you. When they do, don't spit and throw punches. They'll just get mad and you'll wind up in restraints. Then, when you come into the ED we're going to put a face mask on you and give you drugs to calm you down. Then you're just going to tie up a bed for 8 hours while you sleep it off. Here, if the blood alcohol level is less than .350, the patient can be sent home when they're safe to. If it's above that, then they can be admitted to a special service to help them detox. Gets them out of our ED, frees up a bed. Keeps the board open for someone else.
OK, have to run off for another night of fun... oh yeah, and I got my first repeat customer. I admitted him on the 20th, he was discharged back to his nursing home yesterday, and came back again. Don't even get me started on nursing homes or keeping someone a full code. We've kinda covered that. So for now, the soap box stays put away.
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