I've been working on wedding preparations these two nights off. Night is a great time to work. There's no distractions: like a television, and the cats don't play with all the ribbons and things I am using for the various projects I need to complete and ship within the next three weeks.
I've avoided blogging about my wedding on this site mostly because I wanted to keep it focused on Emergency Medicine and my residency training experiences. I have a bunch of pictures, etc. on my Facebook.com site. So, if you have an account, you can check me out there...
However, the last two days I've thought back to my college days and some issues I had during my sorority initiation. Mostly, I was always late to meetings. They didn't have any repercussions for being late, and I was usually only about 5 - 10 minutes late. But, they got me back during Initiation Weekend. As my punishment, I had to wear every house member's watch (somewhere around 15) and before I was allowed to speak I had to say, "I'm late, I'm late, for a very important date, no time to say hello, good-bye, I'm late, I'm late, I'm late." And then give the current time. (For all you Greeks out there aghast that I am spilling initiation secrets loosen the sphinctone. I graduated from college almost 20 years ago, and I doubt anyone in the house (SigThX) is going to come after me.)
That's kind of how I feel right now. I have so much to do, and I feel like I am running quickly out of time. By the way, my wedding is on the OTHER side of the country, so everything has to be done about a week before I leave so I can ship it. I am still trying to figure out how to carry my dress, which is "poofier" than I remembered, onto the plane. Any suggestions?
Ok. That's about it right now. I am on vampire time, but need to get some kind of nap in since we have meetings in the morning as it's Grand Round Wednesday. Then I go back to work for my last 3 shifts of this rotation. Free weekend coming up. Superbowl Sunday. Sigh, I have so much to do...
Tuesday, January 29, 2008
Monday, January 28, 2008
E.D. Rollercoaster Ride
One day you're rushing around like crazy, getting slammed on all sides, and the next night you're sitting around discussing the death of Princess Diana, hypothetical situations necessitating "opening and packing" trauma patients, socialist medicine, and Latin phrases. Of course, the first one most physicians learn is "Primum non nocerum" - First do no harm.
In our case, my attending gave me several Post-it notes with the letters "FOS" on them. Usually, FOS means "Full of S*&#" most often referring to a CT scan or abdominal x-ray showing copious amounts of, well, S*&#. But, in this case, my attending was referring to himself being, "Full of Science." He gave them to me with the understanding that I could stick one to his white coat if I felt he was giving me too much information from the medical literature which had nothing to do with the current patient's condition. It's a medical/science thing so maybe not funny to you, but seriously laugh a minute to us.
As you can guess, the patient load was low. I think the first 3 patients I saw, I went in, evaluated them, determined there was really nothing to do with them, and we sent them on their way with reassurance that they were fine and needed nothing further. My fourth patient had a migraine, so I gave them some medication, they felt better, and off they went. My next 2 patients kept me busy with labs and such until about 3 in the morning when there were no more patients waiting, and my attending said I could leave. So I did.
I had that evening free and this evening free. In case you're paying attention to the time, this is now Tuesday morning. Because I am trying to keep my Vampire hours and my internal clock set appropriately, I am keeping myself awake for as long as I can. Then I'll take a "nap" for several hours before doing this all over again. I go back to work on Wednesday night for the next three nights, and then, believe it or not, I am done with this rotation. My next is anesthesia which will be sort of like the free for all that ultrasound was except with needles and breathing tubes.
Since the two more complicated patients were rather boring, I won't bore you with their details. Suffice it to say that sometimes I miss working at a place like Brigham and Women's in Boston. I miss havingthe ability to perform whatever procedure is deemed necessary. The challenge of rural medicine is making due with what you have and being able to stabilize patients given your resources. Which is where the conversation about "opening and packing" came in.
Princess Diana officially died of a tear in her pulmonary vein leading to her bleeding out into her chest. Had she been in the U.S. her likelihood of survival would have been higher given that EMS units here follow the edict of "Scoop and Run." Serious patients aren't managed in the field, they are brought to a hospital for more definitive care. Not so in France. They try to stabilize in the field. According to official reports, it took almost 2 hours for her to be brought in to the hospital because the ambulance crew first tried to stabilize her in the field and then actually stopped en route to the hospital when her blood pressure fell.
My discussion with my attending had to do with "cracking the chest" and then trying to temporarily repair the damage so that the patient would survive transport to ECMC which is the closest major trauma center. In trauma surgery sometimes you open a patient with massive bleeding and just pack everything off and then go back in later when you have the patient more stable. It's called "Damage Control" surgery. You just hope to get the patient through the physiological processes that happen after major trauma so that they can survive the surgery that will actually repair the physical damage.
So too in the rural E.D. setting. I guess you can think about it like a M*A*S*H setting. You don't do anything fancy. That comes later. Keeping the patient alive long enough to be ultimately repaired is the goal. Anyway, we had a lively discussion of scenarios and possible means of repair. He had a lot of war stories to tell, and I can appreciate the need to work within your abilities and resources.
As for my cancer patient from the day before, they pulled out 550 cc of fluid from her lung, and it looked much improved on chest x-ray today. If you remember the bottles from some of my prior entries, it would be a 1/2 liter; about the amount of one of those bottles. She still has some fluid there and will probably need that tapped at some later time.
In our case, my attending gave me several Post-it notes with the letters "FOS" on them. Usually, FOS means "Full of S*&#" most often referring to a CT scan or abdominal x-ray showing copious amounts of, well, S*&#. But, in this case, my attending was referring to himself being, "Full of Science." He gave them to me with the understanding that I could stick one to his white coat if I felt he was giving me too much information from the medical literature which had nothing to do with the current patient's condition. It's a medical/science thing so maybe not funny to you, but seriously laugh a minute to us.
As you can guess, the patient load was low. I think the first 3 patients I saw, I went in, evaluated them, determined there was really nothing to do with them, and we sent them on their way with reassurance that they were fine and needed nothing further. My fourth patient had a migraine, so I gave them some medication, they felt better, and off they went. My next 2 patients kept me busy with labs and such until about 3 in the morning when there were no more patients waiting, and my attending said I could leave. So I did.
I had that evening free and this evening free. In case you're paying attention to the time, this is now Tuesday morning. Because I am trying to keep my Vampire hours and my internal clock set appropriately, I am keeping myself awake for as long as I can. Then I'll take a "nap" for several hours before doing this all over again. I go back to work on Wednesday night for the next three nights, and then, believe it or not, I am done with this rotation. My next is anesthesia which will be sort of like the free for all that ultrasound was except with needles and breathing tubes.
Since the two more complicated patients were rather boring, I won't bore you with their details. Suffice it to say that sometimes I miss working at a place like Brigham and Women's in Boston. I miss havingthe ability to perform whatever procedure is deemed necessary. The challenge of rural medicine is making due with what you have and being able to stabilize patients given your resources. Which is where the conversation about "opening and packing" came in.
Princess Diana officially died of a tear in her pulmonary vein leading to her bleeding out into her chest. Had she been in the U.S. her likelihood of survival would have been higher given that EMS units here follow the edict of "Scoop and Run." Serious patients aren't managed in the field, they are brought to a hospital for more definitive care. Not so in France. They try to stabilize in the field. According to official reports, it took almost 2 hours for her to be brought in to the hospital because the ambulance crew first tried to stabilize her in the field and then actually stopped en route to the hospital when her blood pressure fell.
My discussion with my attending had to do with "cracking the chest" and then trying to temporarily repair the damage so that the patient would survive transport to ECMC which is the closest major trauma center. In trauma surgery sometimes you open a patient with massive bleeding and just pack everything off and then go back in later when you have the patient more stable. It's called "Damage Control" surgery. You just hope to get the patient through the physiological processes that happen after major trauma so that they can survive the surgery that will actually repair the physical damage.
So too in the rural E.D. setting. I guess you can think about it like a M*A*S*H setting. You don't do anything fancy. That comes later. Keeping the patient alive long enough to be ultimately repaired is the goal. Anyway, we had a lively discussion of scenarios and possible means of repair. He had a lot of war stories to tell, and I can appreciate the need to work within your abilities and resources.
As for my cancer patient from the day before, they pulled out 550 cc of fluid from her lung, and it looked much improved on chest x-ray today. If you remember the bottles from some of my prior entries, it would be a 1/2 liter; about the amount of one of those bottles. She still has some fluid there and will probably need that tapped at some later time.
Sunday, January 27, 2008
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!
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!
Saturday, January 26, 2008
The Night of Water Torture
It was a looong night.
I didn't write about Thursday night because I only saw 4 patients, and they weren't that interesting. Again, little odd and end things that should have been seen in their own doctor's office. Of course, I did have a group of unruly teenagers who were out "jumpin fences" at 11 p.m. and one girl got hit in the face by a flying elbow. Five sutures across her eyelid which took me less than ten minutes but which had been preceded by 45 minutes of drama. That was about the excitement of the night.
That and the fact I haven't been in a Denny's after hours since before med school, and I decided to stop on my way home yesterday morning since, for some unknown reason, I was craving steak and eggs at 4 in the morning. There was a boisterous crowd for a Thursday night, and the steak was cooked just right. Ah, memories of youth.
But, I digress. Last night was torturous. Not only because of the types of patients we were seeing, but because instead of coming en masse, they showed up as one about every 30 minutes. All night long. It really is torture. You think you've finished up on your last patient and then there's a new one. You're almost ready to discharge that one, and another appears. And, as I said, they appeared almost like clockwork: every 30 minutes.
Last night's sampling brought us:
- a young girl who we were sure had appendicitis, and then her CT scan came back negative. We're still not convinced, so she's coming back tonight for a re-check
- a tragic young woman who has spina bifida (spine didn't completely fuse at birth, usually in just one spot) and has undergone multiple surgeries to help stabilize her spine. Unfortunately, her most recent surgery a year ago lead to complications and a wound infection with MRSA (which you've been hearing so much about in the news), and she had been through a year of debilitating illness and was on the edge of a nervous breakdown. She's facing another surgery and has no emotional support from her significant other or her family. My attending was making arrangements for further care when I left.
- guy with a toothache that said he couldn't get in to see a dentist for 2 more weeks and the pain meds he had been prescribed 2 days prior from the E.D. weren't working. If you know 800 mg of motrin will work for you and you have a prescription for 600 mg, why don't you just add 200 more of regular strength? Seriously, there is no magic formula in the pills that are 800 mg. It's all the same stuff. Really. He didn't agree and left in a huff.
- guy in a snowmobile accident. Apparently there is a huge snowmobile enthusiast population where I am working right now. He was riding and tried to avoid crashing into another machine, but he only ended up hitting the other machine sideways. His ankle was caught in between and now he has a fracture (break) of one of his ankle bones. Splint for him and a referral to ortho.
- and, my idol, a 75 year old woman who still cuts her own wood, drives her own tractor, uses a snow blower on her driveway and still drives. She lost 5 pounds because she was researching her BMI "on the internet" and found out that she was 5 pounds above the recommended weight limit for her age and size. She thought her blood pressure was too high so she came in to get it checked out. She ended up staying with us for several hours longer while we made sure she wasn't having some heart problems and kept her on the monitor. I'll find out what happened when I go back tonight. But, I want to be her when I am that age.
Back for more tonight. I keep hearing rumors of College night Saturday night, so we'll see if they're true.
I didn't write about Thursday night because I only saw 4 patients, and they weren't that interesting. Again, little odd and end things that should have been seen in their own doctor's office. Of course, I did have a group of unruly teenagers who were out "jumpin fences" at 11 p.m. and one girl got hit in the face by a flying elbow. Five sutures across her eyelid which took me less than ten minutes but which had been preceded by 45 minutes of drama. That was about the excitement of the night.
That and the fact I haven't been in a Denny's after hours since before med school, and I decided to stop on my way home yesterday morning since, for some unknown reason, I was craving steak and eggs at 4 in the morning. There was a boisterous crowd for a Thursday night, and the steak was cooked just right. Ah, memories of youth.
But, I digress. Last night was torturous. Not only because of the types of patients we were seeing, but because instead of coming en masse, they showed up as one about every 30 minutes. All night long. It really is torture. You think you've finished up on your last patient and then there's a new one. You're almost ready to discharge that one, and another appears. And, as I said, they appeared almost like clockwork: every 30 minutes.
Last night's sampling brought us:
- a young girl who we were sure had appendicitis, and then her CT scan came back negative. We're still not convinced, so she's coming back tonight for a re-check
- a tragic young woman who has spina bifida (spine didn't completely fuse at birth, usually in just one spot) and has undergone multiple surgeries to help stabilize her spine. Unfortunately, her most recent surgery a year ago lead to complications and a wound infection with MRSA (which you've been hearing so much about in the news), and she had been through a year of debilitating illness and was on the edge of a nervous breakdown. She's facing another surgery and has no emotional support from her significant other or her family. My attending was making arrangements for further care when I left.
- guy with a toothache that said he couldn't get in to see a dentist for 2 more weeks and the pain meds he had been prescribed 2 days prior from the E.D. weren't working. If you know 800 mg of motrin will work for you and you have a prescription for 600 mg, why don't you just add 200 more of regular strength? Seriously, there is no magic formula in the pills that are 800 mg. It's all the same stuff. Really. He didn't agree and left in a huff.
- guy in a snowmobile accident. Apparently there is a huge snowmobile enthusiast population where I am working right now. He was riding and tried to avoid crashing into another machine, but he only ended up hitting the other machine sideways. His ankle was caught in between and now he has a fracture (break) of one of his ankle bones. Splint for him and a referral to ortho.
- and, my idol, a 75 year old woman who still cuts her own wood, drives her own tractor, uses a snow blower on her driveway and still drives. She lost 5 pounds because she was researching her BMI "on the internet" and found out that she was 5 pounds above the recommended weight limit for her age and size. She thought her blood pressure was too high so she came in to get it checked out. She ended up staying with us for several hours longer while we made sure she wasn't having some heart problems and kept her on the monitor. I'll find out what happened when I go back tonight. But, I want to be her when I am that age.
Back for more tonight. I keep hearing rumors of College night Saturday night, so we'll see if they're true.
Thursday, January 24, 2008
Community Photo Challenge - Hometown
Hometown to me has always been the town square, especially in a downtown metro setting, and at night when it's quiet and everything seems magical.
I couldn't decide between the two because I love photos in black & white, so I am putting both.
I couldn't decide between the two because I love photos in black & white, so I am putting both.
Wednesday, January 23, 2008
The Night Life
It's been a real pain trying to adjust to the night shift. I didn't write about my first night shift Monday night since I got in Tuesday morning and went right to bed. Then evening came, and I was trying to stay awake and failed, which didn't matter since I had to get up early this morning to go to Wednesday Grand Rounds. Suffice it to say I was lazy then tired, then it just didn't seem relevant.
I think I only saw about 6 patients Monday night, and they were all follow-ups or issues that should have been handled in their PMD's office during regular hours. However, I was told by one patient who came in with 3 days of fevers that the earliest she could get into her PMD's office would be in 2 weeks. She had a pretty good case of strep throat, and I didn't feel bad about writing her a script for pain meds and antibiotics. Having been through it before, I could understand how miserable she must be feeling.
We cleared the E.D. by about 1:30 in the morning, and I didn't see my next patient until 5 in the morning when I was just about to walk out the door. I stayed to write them up and get things going for my attending and then drove home. I have to admit. I am a morning person. I love bringing in the new day. One of my favorite times is being on the road just as the sun is rising. There's something so perfect in that moment. The world is suddenly full of possibilities. Things to do, things to see, adventures to start.
Of course, I then come home and crash into the bed for about 10 hours of sleep. But the thought is there... You just can't concentrate buried under warm blankets, piled on by 25 pounds of warm kitties...
I'll stay up most of tonight/this morning. Keep the internal clock set to "Vampire." We'll see what my next shift has to bring as the weekend fun begins...
I think I only saw about 6 patients Monday night, and they were all follow-ups or issues that should have been handled in their PMD's office during regular hours. However, I was told by one patient who came in with 3 days of fevers that the earliest she could get into her PMD's office would be in 2 weeks. She had a pretty good case of strep throat, and I didn't feel bad about writing her a script for pain meds and antibiotics. Having been through it before, I could understand how miserable she must be feeling.
We cleared the E.D. by about 1:30 in the morning, and I didn't see my next patient until 5 in the morning when I was just about to walk out the door. I stayed to write them up and get things going for my attending and then drove home. I have to admit. I am a morning person. I love bringing in the new day. One of my favorite times is being on the road just as the sun is rising. There's something so perfect in that moment. The world is suddenly full of possibilities. Things to do, things to see, adventures to start.
Of course, I then come home and crash into the bed for about 10 hours of sleep. But the thought is there... You just can't concentrate buried under warm blankets, piled on by 25 pounds of warm kitties...
I'll stay up most of tonight/this morning. Keep the internal clock set to "Vampire." We'll see what my next shift has to bring as the weekend fun begins...
Sunday, January 20, 2008
Going into Vampire Mode
I haven't written since I've had the last couple of days off, and I was just too tired on Friday after another super busy day in the E.D. At one point, we had 6 charts waiting to be seen and ambulances kept arriving with even more critical patients that would have to be seen first.
I was seeing patients at 4 in the afternoon that had been triaged (assigned level of severity) around 11:30 that morning. Part of the problem, and something I am sure is going on around the country, is that issues that would normally be handled in a primary care office setting were being sent to us. I must have talked to 5 or 6 patients, that when I asked why they came into the E.D. with their problem replied, "I called my primary medical doctor (PMD) who told me they were booked and to go to the E.D."
On a couple of those, my attending and I looked at each other and went, "and what are we supposed to do with this...?" For example, we had two patients who came in complaining of breast pain. One thought she felt a lump, and the other thought she had drainage from one of her nipples. Unless they had an abscess that needed to be drained, which neither did, we wouldn't do much other than refer them back to their PMD to follow-up with a mammogram.
These patients tie up our time from more serious patients, like the man having a heart attack, the young boy with the severe asthma attack or my LOL NAD who fell face forward and needed almost a trauma work-up since she managed to injure herself pretty well. Also, it took me almost 2 hours to put sutures in another patient because I kept getting pulled to other rooms.
Nurses don't get enough credit sometimes. We were so busy that the nurses were preemptively putting in orders, so that on a few of the later patients all I did was basically walk into the room and be ready to discharge or admit the patient on the spot given I had labs and/or films already done.
I stayed late to help clean up a bit. When I left, there were only 2 more patients waiting to be seen, and no one waiting in chairs. Starting tomorrow night I work the night shift, so I will be staying up as late as I can tonight and then taking a nap tomorrow as I try to adjust my clock to vampire mode.
We'll see what the night brings to this some-what sleepy little town...
I was seeing patients at 4 in the afternoon that had been triaged (assigned level of severity) around 11:30 that morning. Part of the problem, and something I am sure is going on around the country, is that issues that would normally be handled in a primary care office setting were being sent to us. I must have talked to 5 or 6 patients, that when I asked why they came into the E.D. with their problem replied, "I called my primary medical doctor (PMD) who told me they were booked and to go to the E.D."
On a couple of those, my attending and I looked at each other and went, "and what are we supposed to do with this...?" For example, we had two patients who came in complaining of breast pain. One thought she felt a lump, and the other thought she had drainage from one of her nipples. Unless they had an abscess that needed to be drained, which neither did, we wouldn't do much other than refer them back to their PMD to follow-up with a mammogram.
These patients tie up our time from more serious patients, like the man having a heart attack, the young boy with the severe asthma attack or my LOL NAD who fell face forward and needed almost a trauma work-up since she managed to injure herself pretty well. Also, it took me almost 2 hours to put sutures in another patient because I kept getting pulled to other rooms.
Nurses don't get enough credit sometimes. We were so busy that the nurses were preemptively putting in orders, so that on a few of the later patients all I did was basically walk into the room and be ready to discharge or admit the patient on the spot given I had labs and/or films already done.
I stayed late to help clean up a bit. When I left, there were only 2 more patients waiting to be seen, and no one waiting in chairs. Starting tomorrow night I work the night shift, so I will be staying up as late as I can tonight and then taking a nap tomorrow as I try to adjust my clock to vampire mode.
We'll see what the night brings to this some-what sleepy little town...
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