Does the sun shine in Buffalo?

Ok, so this morning I got up extra early for a shower before my hour's drive to my new rotation: ED in a small, 9 bed community hospital.  The sky was dark all the way to work.  When I left at around 5:30 p.m., the sky was dark all the way home.  Luckily, I have a lot of days off, so I am sure I will see the sun at some point.

So, new hospital and learning a new system and getting used to new attendings, etc.  I found out today that most of the patients have most of the same complaints.  However, small town life can be a bit more colorful at times, and patients here have a tendency to be frequent fliers.  I also like being back in a position of having everything I need brought to me. 

When I was a house doc working at the community hospital, whatever I needed was immediately retrieved and brought to the bedside.  There was even a situation where I was called to a patient's bedside for SVT (it's a very fast rhythm) in the middle of the night.  My mouth was so dry, and gross (ew, morning breath at 2 a.m. is not fun) that all I wanted was a piece of gum.  I related such to the nursing supervisor that came to every call with the Rapid Response team.  A few minutes later a floor nurse came up and asked if I was the House Doctor.  I said, "yes," and she handed me several sticks of gum that had been tubed to the nurses' station.  Now that's service!

But, I digress.  The nurses indeed were very friendly and happy to set up eye kits, ENT kits, and, ughhh, pelvic setups, when asked.  Orders magically disappeared and were entered expeditiously, and the ED hummed along.

I saw about 8 patients today.  We suddenly got very busy about the time I was leaving so I had to sign out a couple of my more interesting cases.

There was:

Bartender who got hit in the eye with a spitball.  Take these eyedrops and consider safety goggles at work. - corneal abrasion

Mr. Elderly man with knee pain for over 20 years that still hurts.  "What are you going to do to make it better?"  MRI shows a lesion on the end of his thigh bone.  Looks like cancer.  Dude, you get any drug you want from me.  From my attending, not so much.  We advanced his ortho appointment by a few days and gave him a little something for the ride home to help his pain.  For now.

Bipolar, borderline personality with depression lady who came in complaining of chest pain after being on the road for 2 days.  No DVT and no heart attack that I could tell on prelims.  She'll probably be let loose to continue her way home to New England. - most likely some sort of panic attack

I'm-pregnant-with-child-number-nine (yes, nine)-at-age-29 (that's right)-and-I-have-belly-pain.  My ultrasound skills showed a happy bouncing baby swimming in a sea of amniotic fluid.  Poor kid doesn't know what's waiting on the other side.  Mom's smoking, of course.  ("I cut down to just 6 or 7 a day.") Ugghh, pelvic with gross everything.  Doesn't look like a miscarriage, and I will have to check her cultures.  Most likely some pelvic inflammation.

Recovering drug addict sent from clinic for high blood pressure.  He'd had nothing to eat but a piece of toast and some coffee... His usual 5 - 6 cups.  Plus his cigarettes.  Around a pack and a half a day.  After walking a half mile to the appointment and climbing stairs I'd look a little ragged too. Sent him right back out as his blood pressure was normal on two readings, and he had no other symptoms.

Lady with weird groin pain "going down into my leg."  Couldn't see anything on ultrasound, but she had a lump.  She was being wheeled to CT as I was leaving so I will have to find out what happens later.

And, finally, just fresh off the cardiac care unit service, I got a "I had chest pains yesterday, but I didn't want to come in, and today my wife made me and now I have EKG changes."  He's being worked up for an MI, and I signed him out as well, so I'll have to see what happens to him.

That's it.  Tomorrow is Wonderful Wednesday with Grand Rounds and no work for me....

Tags: community ED, EKG, ACS, multiparous