Final Friday Fracas

That was my last look at the ambulance entrance to the small town hospital where I've been working for the last month.  It was just after 5:00 a.m., and it had been one helluva night.  I alluded to my musical selection hoping it wasn't going to be predicative of the night, and it was.

When I got there, there was already a 2 hour wait for non-urgent cases.  After developing a "room congestion" problem where we couldn't get patients in or better OUT of the E.D. we increased to a 3 - 4 hour wait.  One thing I have to comment on, when people are told they're going to have to wait several hours, they usually leave unless they're really sick.

Better for us in that we don't have to deal with patients that could wait to see their physicians in the morning or wait until Monday.  However, those that do stay around (because they have nothing better to do?) and aren't very urgent are the type of patients that push us over the edge and lead to heavy sarcasm and disdain for most people. 

When I have a patient come in and say they have 10/10 pain, they've been constipated for over a week, they were seen in the E.D. a week ago AND have been seen within the last week by their PMD, AND they haven't taken anything for the pain or tried to do anything for their constipation, I take pause.  I think back to my last threat that I would personally rip the arm off of any patient who lay comfortably in their bed and said they were having 10/10 pain and beat them with it.  If that then was a 10/10, what would they now rate their prior pain?  But, I don't.  Hippocratic oath and threat of legal retribution aside, because I am a good person.  Yep, I tell myself that every day as I slip into my white coat and go forth to face the masses yet again.

We saw 28 patients between 7 p.m. and about midnight.  That's not a lot when you consider the times I told you ECMC had their 20 rooms full, plus the Fast Track rooms and the hallway.  But there is more than one doctor on at a time.  At this small 9 bed E.D., had I not been there (and, really, since I am in training I count like about 1/2 a doctor), there would only be one doctor.  You have to be fast on your feet, clear of mind, and able to multi-task like a one-armed octopus at a paper factory.  (Don't know how I came up with that analogy, I think I heard it somewhere.)

Suffice it to say, we were busy.  My mix of patients included:

 - girl with toothache.  Seriously, good dental care and stop smoking.  Pain meds and go see your dentist.

 - man with eyelid surgery infection.  Poor form:  if you're going to operate on someone you take responsibility for the care of your patient.  You don't leave them without coverage.  We had to call in another eye doctor, not from the same group to come in and clean up the mess since this patient's sutures and wound were falling apart.

 - woman with cough - not bronchitis, post-nasal drip.  It's difficult treating a patient with heart disease and high blood pressure for congestion as the best decongestants interact with their medications.  But, a quickie Google search, and I found some alternatives.

 - victim of domestic abuse with finger fracture.  I feel bad she got beat up, but then less so when I found out she was well known for getting drunk, along with her husband, and then getting into physical rows with him.  Both have been in several times for fixing this or that wound/laceration/broken bone.  She gets a splint.

 - drunk with broken shoulder.  He was helping his friend down some stairs and then fell himself.  We couldn't let him go home alone until he was sober, and he couldn't sleep because of the pain so he wandered up and down the corridor asking when he could go home.  He was still there when I left.

 - 10 days of constipation and nothing was working.  We gave her one of the known GI bombs - Magnesium citrate.  It will usually clear out anything in your intestines from top to bottom.  I honestly don't know what else to give if that didn't work.  I warned her to be home in half an hour after drinking it.  I've heard stories... I didn't want to see the results.

 - guy with earache.  Adults can get ear infections.  He did.  He got drugs.  He went home.  Waited 3 hours, and I had him out in 15 minutes.  He was pleasant enough.

 - teen with asthma attack.  Again, don't smoke if you have asthma and don't go and roll all over the floor at your friend's house who has dogs, oh, and carry your inhaler with you.  She was fine by the time I saw her.  She didn't like the lecture her mother and I gave her about the dangers of smoking.  Who knows.

 - 2 women, 10/10 abdominal pain.  If you're not lying on the gurney, curled up in fetal position, crying and calling for your mama, I don't believe you.  I've examined your bellies and you've gone through childbirth.  Please, I've heard you "forget" the birth once you've had your baby, but still.  One I talked about the beginning.  She was carrying on a conversation with "drunk with broken shoulder" who was in the next bed when I left, and the other got sent home with some anti-acids.

 - and, finally Alzheimer's feisty lady who'd been in a car accident.  She wouldn't let me examine her.  She took a swing at me.  And, since she was obviously moving all of her limbs and walking just fine as she tried to escape out the door, I would say she wasn't injured in the car accident.  The daughters agree that without sedation she would never lie still for a CAT scan of her brain, and since we'd already torture the poor woman just by making her wait for so long, they took responsibility for her and said they'd bring her back if there were any signs of a concussion.

Well, that's it.  I took a long nap and am trying to tire myself out so I can switch back to daylight mode.  I have today off to enjoy the Big Game - Go Patriots!  I will also continue working on wedding stuff since we're now in the month of February... eek!!

Tags: super bowl, constipation, magnesium citrate, pain rating system, asthma, domestic abuse

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