Graveyard in the ER
Quality night in the ER, hour by hour.11pm: Arrival and picking up my first patient. My mentor is there signing off, but I check in with the chief resident like I am should. I pick what I thought was straightforward ToothExtraction. TE turns out to be more complicated due to uncontrolled diabetes and blood sugars in the 600s. And TE had a bleeding tooth, one of multiple tooth extractions if my tooth numbering is anything to go by. There isn't any signs of fever, which is good with TE is allergic to penicillin.
Midnight: With TE getting DKA ruled out and a consult to dentistry, time for a new patient. Lucky for me around 1 am, ItchyHives roles in. IH woke up this morning with hives that have spread to the face and starting down the legs and arms. IH also has 'strep' which was treated with amoxicillin. Mono and strep have similar presentations so I get permission to call the lab and find out how long it takes for an EBV test for mono to get back.
1am: Dentistry says we should just pack TE's tooth and recommend follow up with the dentist that pulled the tooth. Oh yeah, and deal with TE's blood sugar medically because they don't know what to do. IH wants the hives to stop itching and will consent to the mono test. That patient will get some anti-histamines, steroids, and the door as soon as we can get the paperwork through.
2am: TE has stopped bleeding and the CBC/chem 7 show blood sugar in the 300s, but no DKA. Hopefully soon as some fluids get in TE and the paperwork finished, TE will be out the door. I use my mentors 'paperwork makes the world go round' line to tell TE it could be a while. I pick up BackPain who has been transfered from an outside hospital. After spending some time with BP, it appears the 'pain' is supratentorial in nature due to a very inconsistent physical exam. BP claims 'numbness' over a non-existent dermatone and a paralyzed leg which is 'unparalyzed' when BP turns over to let me do my lung exam.
3am: The bars are closed on this Friday night so everyone comes in with their drunk related traumas - namely DrunkGuys 1-5, mostly cuts. A few traumas come in but they are claimed by surgery (hi other medstudents doing trauma call!) IH has been sent home. BP is getting scanned, and TE is still waiting on paperwork. I head off with one of the interns to stitch up DG1 who is accompanied by his uninjured friend DG1a. The intern leaves to go get something, and I get stuck with DG1 and DG1a hitting on me because they must have seen too many episodes of Grey's Anatomy. I try to ignore them as I wait for my intern to come back and rescue me. It takes a long time.
4am: Still sewing up DG1, while my resident takes care of DG2 and DG3. There is a really nasty FaceCut that plastic surgery is coming down to sew up. There is no hurry and DG4 who is pretty altered (aka stuporous drunk) needs his skull lac stapled. With the 3am rush of patients finished, triage is empty and the board is emptying. BP's scans are clean and it is time for the discharge to be repaired. BP is very needy and wants attention, but none of it is the ERs problem. We just can't fix BP's martial problems and depression here.
5am: Nothing new on the board. DG1 and DG1a with their HotFriend leave. DG4 is so out of it, he doesn't really do much when I put 3 staples in the back of his head. TE's paperwork is finally finished and out the door at last. I hang out with the residents and try to do some of my family practice reading.
6am:BP is being discharged but still wants attention . . . and more pain meds. I can't solve BP's problems. I go to check out FC and happen to be in there while 2 docs from plastics are checking out the injury. Note to self: never get in a bar fight with glass involved. Plastics leaves to go fill out some paperwork and will come back later. I only have a few minutes left in my shift and am not picking up the new patient RotatorCuff. Trauma arrives and in come the surgeons and their trauma med students. Note to self: sharp objects are pointy and dangerous. HotSurgeon that I knew from internal med is in charge, but since someone is bleeding, he doesn't see me. I'm fine with that.
7am: BP has finally left and I'm getting ready to leave too. Then plastics comes back and recruits me to watch them suture FC. I know this is a learning experience, but I want to go home. I'm smart enough to not say that because unless you are an ER doc, no one understands 'my shift is over and I want to go home.' The two surgeons try to sell surgery to me. I'm smart enough to plead undecided because I don't want to be pimped or piss them off. We discuss safer topics like Grey's Anatomy and Nip/Tuck as FC sleeps through the entire procedure.
8am: FC is all sewn up with 30-40 stitches. I'm free to go. I check in with my program director for further plans this week. He thought I went home an hour earlier. We rearrange my schedule a little bit for the week. I'm going to spend a long time putting in IV's on Wednesday. I bundle back up and walk out of work into a bright bright sunshiny day. I'm totally going to bed. I'm asleep by 8:30 am.
posted by Allie @ 8:08 AM
3 Comments:
I certainly hope you don't see your patients as just sets of symptoms. I understand your desire to protect confidentiality, but turning your patients into mere medical maladies is a habit you should avoid.
This was just a 'day in the life' type entry for someone at the ER. I went as far as hiding the genders just so that it stayed confidential.
plus, it's probably a way to keep them straight in the head - when i'm in clinicals or at work, when speaking to other nurses or co-workers, i refer to the patients by the number of the room they're in. it keeps it straight for me. keeps it relatively private, too. however, to the patient's or family member's face, i will refer to them by first name or whatever they want to be called.
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