Monday, October 29, 2007

It's Just Another Manic Monday

Beer meter: 

Ok, so the floodgates opened yet again.  The E.D. was FULL of patients and about 50% of them were chest pain patients.  And, it seemed like all of the other E.D.'s were full and sending us their patients.  There's been news that several E.D.'s in the area will be closing, and that just means more congestion for the E.D.'s that remain open.

Politics aside, my patients for today:

Chest pain - admit with pneumonia - coming in and making demands is not a good way to make friends in the E.D.  I love hearing the "why I am not compliant with my medication" stories about how awful their doctors are and how they never give them their prescriptions when they need them;  and then, when I call their doctors to admit them, I hear the other side of the story, how the patients don't come into clinic for follow-up appointments, or how they call saying they've "run out of all of their medications and need them refilled today."  For some reason I believe their doctor's side.  Don't know why, just a gut feeling.

Shortness of breath - admit with COPD exacerbation - COPD = emphysema.  Somehow I don't care if you're 92 going to turn 93 tomorrow.  You really shouldn't smoke... still.  Maybe that's the reason you need to wear oxygen... no smoking with that on, or you'll go up in flames.

Shortness of breath - discharge with upper respiratory infection - I don't care what the bottle says, if it smells like horse liniment it probably isn't something you should take to "clear out your chest congestion."

Abdominal pain - admit with small bowel obstruction - cancer sucks when it happens to really nice people.  What sucks even more is being a doctor who can look at a CT scan and go "oh crap that's a BIG tumor."  When I was at in medical school, one of my attendings used to make the comment, "All he needs is a script for a cane pole and a six pack" meaning a patient had cancer with no hope.  There's always hope, but looking at my patient's CT, I wondered if he'd even have time to hook the worm.

Chest pain - admit to chest pain center - seriously, stop doing the cocaine and the chest pain will stop.  Or your heart will.  Either or, the pain will be gone.

Abdominal pain - probably will be admitted with a pancreatic pseudocyst - if you're told you have pancreatitis and to not drink and you chose to block out the pancreatitis part and still drink, when you come back again with abdominal pain and you tell me you don't know why, I am going to find out.  Electronic medical records are a great thing.

Chest pain and abdominal pain - most likely going to be discharged with nothing wrong except for the fact you haven't been able to get your methadone for the last four days so you're coming to the E.D. for your fix.  Oh, and when I ask for significant medical history, telling me you're biologically a man who now dresses like a woman is important so I don't look silly/stupid in front of the nurses when I ask for a urine pregnancy test.

Day off tomorrow.  I'm on a strange day on/day off/switch over to the night shift thing for the next week.

Monday, October 15, 2007

Sunrise, Sunset

Well, I lived through it.  My first official month as an EM resident.  33 more to go.  As I drove away from work this morning, I actually thought, "I'm gonna miss it (the ECMC E.D.), just a little."  It's sort of like being back in medical school.  You just start to get comfortable in a rotation, then it's time to shift again.

Last night wasn't too bad.  I had a period of about 3 hours where I had one patient on the board, and they were basically sleeping in the E.D. waiting for a bed upstairs.  I did get to do a trauma on my own.  A 25 foot fall from a tree stand while hunting will knock the wind out of you.  Not to mention breaking a couple of ribs, your arm, some important parts of your neck bones.  Yep.

One major event that made me miss my trauma days was a double stabbing.  You stab me, I stab you and we both end up in the E.D.  There's a bit of excitement in running down the corridor with your hand covering someone's gushing wound and going right into the O.R.  Last night I stood back and watched them rush by.  I had a finger to sew back together.  My patient would be leaving via the front door; not the morgue door like the trauma patient.

So this morning I sat for a second in the warmth of my car and watched the sun rise.  Pondered my choices in life.  Reflected on what might have been.  But, to be honest, I am looking forward to what will be.  Every day I pick up on something new to study, something I want to be better at doing, another skill I want to perfect. 

And sometimes, yep just sometimes, I get a patient that says "Thank you" and really appreciates that I took the time to help them.  And, that, more than anything makes me want to continue on where I am, what I am doing, this life I am living.