Monday, May 14, 2007
If it ain't broke...
OK, so this lady came into the department with a cough and shortness of breath. According to her, she just needed antibiotics and a sleeping pill. According to me, she was wheezing. She had no history of asthma, so I decided to give her some nebulizer treatments and get a chest x-ray. When the nurse went to get her for an x-ray, the patient told the nurse that she didn't need one, because she knew her chest wasn't broken. Honest and true.
Ranting
There was a story in the Palm Beach Post the other day about senior citizens buying a quick-access card for emergency medical care as part of their condo dues. http://www.palmbeachpost.com/localnews/content/local_news/epaper/2007/05/12/s1a_ER_CONDOS_0512.html
The article states that by showing the card on arrival to the emergency department, a patient will have his or her care expedited. This is the kind of idea that makes Emergency Physicians cringe. In the Emergency Department, no one is supposed to get special treatment. As patients come in, they are seen by a triage nurse and assigned a severity score. The sickest people go first. As they should. People who aren't having an emergency should go to their doctors' offices. But they don't. I have been chewed out by someone with an ankle sprain for a delay in care that was due to another patient's life-threatening condition. I asked him if he would want his grandmother to wait if she were dying and he said, "She should, if I was here first!" Poor grandma.
The underlying problem seems to be the misuse of the Emergency Department for problems other than emergencies. Here are a few advertising slogans I have come up with for the ED:
The VIP Lounge- Are you too important to make an appointment? Come down to the hospital and throw your considerable weight around.
The My-Doctor-Won't-Refill-My-Percocet-Room- Is your doctor blaming YOU for your addiction to narcotics? Go to a doctor who doesn't know you! Then threaten a lawsuit!
Chez Chronic Condition- Are you sick of your chronic abdominal pain? Is a life of bad decisions catching up with you? Come to the ED and kvetch!
The Sick-to-death Room- Have you seen every specialist there is for your numb toe and everyone says you're fine? Do you KNOW you need an MRI but no one will order it? Come to the Emergency Department and use the secret passwords: "I just can't take it any more".
The article states that by showing the card on arrival to the emergency department, a patient will have his or her care expedited. This is the kind of idea that makes Emergency Physicians cringe. In the Emergency Department, no one is supposed to get special treatment. As patients come in, they are seen by a triage nurse and assigned a severity score. The sickest people go first. As they should. People who aren't having an emergency should go to their doctors' offices. But they don't. I have been chewed out by someone with an ankle sprain for a delay in care that was due to another patient's life-threatening condition. I asked him if he would want his grandmother to wait if she were dying and he said, "She should, if I was here first!" Poor grandma.
The underlying problem seems to be the misuse of the Emergency Department for problems other than emergencies. Here are a few advertising slogans I have come up with for the ED:
The VIP Lounge- Are you too important to make an appointment? Come down to the hospital and throw your considerable weight around.
The My-Doctor-Won't-Refill-My-Percocet-Room- Is your doctor blaming YOU for your addiction to narcotics? Go to a doctor who doesn't know you! Then threaten a lawsuit!
Chez Chronic Condition- Are you sick of your chronic abdominal pain? Is a life of bad decisions catching up with you? Come to the ED and kvetch!
The Sick-to-death Room- Have you seen every specialist there is for your numb toe and everyone says you're fine? Do you KNOW you need an MRI but no one will order it? Come to the Emergency Department and use the secret passwords: "I just can't take it any more".
Friday, May 4, 2007
All's well that ends well...
When people hear that I'm an emergency physician, they inevitably ask, "What's the grossest thing you've seen in the ER?" It's a fair question, but what grosses out the average person doesn't bother me at all. I love to open abscesses because of the feeling of satisfaction that comes with each milliliter of pus that pours out. The awful smell just enhances my joy. But now, I have the greatest gross story ever!
Last week, the local police did a raid on a known drug house. Three of the inhabitants thereof surrendered immediately, but the fourth, who later became my patient, barricaded himself into a bedroom. The SWAT team was called in (a little overkill if you ask me) and they broke down the door. Upon entering the room, the police observed future-patient swallowing several packets of cocaine. They brought him to me for "medical clearance" for incarceration.
Let me clarify "medical clearance". A few years ago a local police district had a man die in custody. It was discovered that he had been highly intoxicated and likely choked to death on his own vomit without anyone noticing. Since then, all suspects who are apprehended are brought to the ED for medical clearance. This supposedly takes any responsibility for the patient's welfare off of the police and shifts it squarely on to my shoulders. I even have to see people with no complaints! What am I clearing? I haven't the foggiest.
However, this was a legitimate clearance issue. If the cocaine packets burst inside future-patient-now-current-patient's intestines, he would die very quickly. The patient was also completely crazed on cocaine. He was brought in with his hands cuffed behind his back, screaming obscenities, fighting with everyone, wearing a layer of cocaine powder around his lips (think Dave Chapelle's drug addict sketch). He freely admitted to using "crack, percocet, xanax, and cough syrup with codeine". When I asked about heroin, he got very defensive and told me, "Hell no! I'm a man of god!" We all have our criteria. In any case, it was obvious to me that this man was not going to cooperate with the flushing out of the cocaine packets and wasn't in a mental state to make coherent decisions. His heart rate was 160 and his blood pressure was through the roof. His veins bulged out of his forehead. We gave him some powerful sedatives and he soon conked out. A tube was inserted through his nose into his stomach. We administed what is called "go-lytely", which is an agent that cleans out your intestines really fast. People take it the night before a colonoscopy to give the doctor a squeaky-clean view.
Two hours later, he still hadn't pooped. I listened to his abdomen, which sounded like a volcano getting ready to erupt. The nurse kept checking to see if he had gone. About an hour later, the nurse checked the patient's bottom and saw something sticking out of his rectum. This brave nurse pulled out the object and found himself holding a little baggie with a bunch of money rolled up in it. What a good place to hide your cash! I have always used a wallet but am reconsidering. The nurse had little time to celebrate, though, because he had taken the proverbial finger out of the dyke, and poop flew everywhere! It was all over everything and everyone. And THAT is the grossest thing I've ever seen.
Last week, the local police did a raid on a known drug house. Three of the inhabitants thereof surrendered immediately, but the fourth, who later became my patient, barricaded himself into a bedroom. The SWAT team was called in (a little overkill if you ask me) and they broke down the door. Upon entering the room, the police observed future-patient swallowing several packets of cocaine. They brought him to me for "medical clearance" for incarceration.
Let me clarify "medical clearance". A few years ago a local police district had a man die in custody. It was discovered that he had been highly intoxicated and likely choked to death on his own vomit without anyone noticing. Since then, all suspects who are apprehended are brought to the ED for medical clearance. This supposedly takes any responsibility for the patient's welfare off of the police and shifts it squarely on to my shoulders. I even have to see people with no complaints! What am I clearing? I haven't the foggiest.
However, this was a legitimate clearance issue. If the cocaine packets burst inside future-patient-now-current-patient's intestines, he would die very quickly. The patient was also completely crazed on cocaine. He was brought in with his hands cuffed behind his back, screaming obscenities, fighting with everyone, wearing a layer of cocaine powder around his lips (think Dave Chapelle's drug addict sketch). He freely admitted to using "crack, percocet, xanax, and cough syrup with codeine". When I asked about heroin, he got very defensive and told me, "Hell no! I'm a man of god!" We all have our criteria. In any case, it was obvious to me that this man was not going to cooperate with the flushing out of the cocaine packets and wasn't in a mental state to make coherent decisions. His heart rate was 160 and his blood pressure was through the roof. His veins bulged out of his forehead. We gave him some powerful sedatives and he soon conked out. A tube was inserted through his nose into his stomach. We administed what is called "go-lytely", which is an agent that cleans out your intestines really fast. People take it the night before a colonoscopy to give the doctor a squeaky-clean view.
Two hours later, he still hadn't pooped. I listened to his abdomen, which sounded like a volcano getting ready to erupt. The nurse kept checking to see if he had gone. About an hour later, the nurse checked the patient's bottom and saw something sticking out of his rectum. This brave nurse pulled out the object and found himself holding a little baggie with a bunch of money rolled up in it. What a good place to hide your cash! I have always used a wallet but am reconsidering. The nurse had little time to celebrate, though, because he had taken the proverbial finger out of the dyke, and poop flew everywhere! It was all over everything and everyone. And THAT is the grossest thing I've ever seen.
Thursday, May 3, 2007
Physician, heal thyself
It's been a while, I'm aware. Sometimes, doctors are patients, which is what happened to me. And being a patient really sucks. I've always known that I prefer to be wearing the white coat rather than the blue gown, but until I spent a few years in the gown, I didn't really know how it felt.
Delivering bad news is something I do nearly every day. Hearing bad news is relatively new to me, but I've become an expert. And what I've learned is that it isn't really what you say, it's how you say it. The tone of voice is so important. I wanted to know that my doctors were really sorry things weren't turning out well. They seemed as surprised and as sad as I was. And while that didn't give me the outcome I was seeking, it made me feel so much better.
I'm an emotions-on-my-sleeve kind of gal, but have often felt like I have to hold it in when interacting with patients and their families. Now, I don't hold back as much. I let them know how sad I am for them. And even though I can't change the situation, they feel just a little bit better.
Delivering bad news is something I do nearly every day. Hearing bad news is relatively new to me, but I've become an expert. And what I've learned is that it isn't really what you say, it's how you say it. The tone of voice is so important. I wanted to know that my doctors were really sorry things weren't turning out well. They seemed as surprised and as sad as I was. And while that didn't give me the outcome I was seeking, it made me feel so much better.
I'm an emotions-on-my-sleeve kind of gal, but have often felt like I have to hold it in when interacting with patients and their families. Now, I don't hold back as much. I let them know how sad I am for them. And even though I can't change the situation, they feel just a little bit better.
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