Slammin' Saturday Night

If I was complaining about the day before, I am sorry.  Mostly because we paid for it last night.  We honestly had a 4 - 5 hour wait on non-urgent cases.  At one point we had the helicoptor crew, 2 ambulance crews and a list of patients, all urgent, that needed to be transferred.  And, this was at the START of the evening.  Everything else that came afterward was just icing on an already too full cake. 

Oh yeah, did I mention that it was snowing all over Buffalo and on my way to work?

So let's see what I remember from the blur:

 - pelvis fracture from sledding with her daughter - she was bleeding into her pelvis and ended up being the patient airlifted to ECMC.  The snow had lifted to the point the helicopter could fly out and in.

 - 2 strokes that came in back to back - the first was taken by ground transport to MFGates which is the regional stroke center and the second ended up being more minor and was admitted to our facility

 - the, almost now routine, I'm having a brain bleed oh yeah AND a heart attack, they were transported by ground to the nearest cardiac center

...and those were just some of the patients I personally didn't see.  As for mine.  I can't remember all of them but these are the highlights and some generalizations:

 - if your teeth are bad and rotting and you've had pain for over a week, Saturday night is not a good night to come to the E.D. and then tell us that you just couldn't wait until Monday to see the dentist and you want something for the pain now.  I'm going to stick a big needle into your gums which is going to hurt - a lot - it's going to numb the pain for a couple of hours so you can go home and smoke and drink some more until the Lortabs you demanded kick in.  Oh yeah, lady bleeding into pelvis trumps your pain so stop yelling.

 - I guess if you get to the point you get lung cancer from smoking and now you're on chemo and you can't remember the names of your medications because you're in almost complete denial about your condition you should just keep smoking.  Not going to hurt now and it's the one pleasure you have left, right?  I do have sympathy for the fact that you can't breathe and are having a hard time catching your breath.  It gives me a chance to stick big needles in your chest and drain out the fluid caused by the cancer which is continuing to grow.  The patient was admitted because actually the "fluid" we though we saw on x-ray is probably her cancer getting bigger and taking over one side of her chest.  I'll follow up on the CT scan tonight when I get there.

 - I am sorry that you had to wait 4 hours to have your bloody nose looked at, but since it stopped that means that it probably wasn't that serious.  You don't see it that way and continued to wait despite the fact your nose wasn't bleeding any more.  I am sorry I couldn't do anything for you, but again, if the bleeding has stopped... other than look in your nose and make sure there isn't more bleeding... what else would you like me to do?  I'm sorry...?

 - Some patients win the "Patience" award, like the gentleman who got a thorn in his leg and waited patiently for 6 hours before I could get him into a room to wash-out his wound and make sure there wasn't still a piece of thorn stuck in there.  There wasn't, and he went home still smiling, still pleasant.

 - Stitches on another gentleman who kept me in stitches while I repaired a pretty decent-sized laceration on his finger.  He had also been waiting about 3 hours but kept his sense of humor about him.

 - A bounceback from earlier, a patient with a known pulmonary embolism and DVT with worsening shortness of breath.  They were going to go into the CT scanner when I left at 5 this morning.

 - Kids with cough.  They only had to wait about an hour or so because they came in around 11 p.m. when we were finally cleaning up from all the drama earlier in the evening.

 - And finally, my 300 + pound patient who noticed about a 40 pound weight gain in a month.  He's volume overloaded from his kidney disease, heart disease, and now he is having a hard time breathing from the weight of his belly.  He's also developing cellulitis from the pressure and fluid in his legs.  We stuck a catheter in his bladder and gave him some lasix which is a diuretic (removes fluid by making you pee).  He was admitted.

Whew...!  Those are the patients I remember.  I am sure there were more, and these were just the patients I saw.  They don't include the patients my attending saw, or the PA saw before he left.

I'm heading out the door... we'll see what tonight brings!

Tags: pulmonary embolism, CVA, gingivitis, lung cancer, cellulitis, croup