Monday, June 15, 2015

Week 29: Sir, your wife's knee pain she has had for 2 years....isn't an EMERGENCY. So shush!

I often can't decide if a week went by fast or if it seemed forever long. Usually working in the ER, I'd say the week went by really fast. Monday was especially stressful for my doctor and when she was telling a colleague about it on Thursday, I could have sworn it happened the week before.

So lets dive into Monday. The place was already crazy at around 8:30AM. The patients just kept coming in. At some point, I just started writing patient release notes as soon as I heard their story so that we could discharge them promptly after my doctor treated them. 

Trauma surgery was definitely the busiest that day but the other departments weren't sitting around sipping coffee and watching us run around like chickens with our head cut off....they were running around just like us. The chief of the ER was hyperventilating at one point (not literally but pretty dang close). He wanted us to see patients in the waiting room to decide if they can immediately be sent to radiology instead of being examined in an examination room.

In theory, this might be an elegant way of avoiding the transfer of the patient from the waiting room to the examination room but it also has the potential to create a lot of problems. And it definitely did. We walked out with the next three patient clipboards to see what could be sent to get x-rayed. The first patient had knee pain. We had to exam him properly to see if he even needed an x-ray. So he had to wait until a room was open. The next patient was described on her chart as having a problem with her finger. This really was her smallest problem though. When we asked her what had happened, she paused, looked a bit scared and asked if she really needed to talk about this in public. Of course she didn't have to and we were about to say that it can wait until we have a room (the doctor and I both have a heart and already didn't like the idea of talking in public to the patients), but the patient was quicker and proceeded to tell us that she was badly beaten up by her boyfriend. She proceeded to break down and cry. Understandably and the doctor and I stood there mad at the chief for having made us do what we did. The third patient fit the theory quite nicely, hurt his wrist while playing soccer. Quick examination of the wrist (which is possible without an examination room obviously) and immediately sent him to get it x-rayed. 

The load of patients just didn't stop. One patient, who came with her husband due to knee pain she has had for 2 years(!!!!!!!!!), was examined by us and we needed one of the attendings to lend us a hand with figuring out what she might have. (I remind you that we work in the Emergency Room, this was not an emergency and we aren't there to do lengthy investigations, we are there to treat acute problems.) 

After her examination, a poly-trauma came in and we were all busy with that. So this couple ended up having to wait a while. When we finally did get to telling them that they need to see an orthopedic surgeon for further evaluation, the husband was not pleased. He quite sternly and not nicely told my doctor that this was absurd and that its an abomination that we simply "petted" his wife's knee and made them wait three hours to be told they had to go see an orthopedic surgeon. At some point, it was too much for my doctor and she started to cry and excused herself. (For people who regularly read this blog might remember my similar situation in urology. Although I didn't cry in front of anyone I was very empathetic for my doctor). I was not as emotionally involved in the situation and still stood there with the couple. I tried to calmly explain to the man that due to the poly-trauma which was an actual emergency, we couldn't finish up his wife's case any quicker and that I understand that waiting is annoying but that it was an emergency room and his wife's issue was flat out not an emergency. I also mentioned that as doctors, we are trained to gather a lot of information from simply observing the patient and "petting" their knee. 

He kept going on about how his wife's heart is bad and how despicable it is that we made them wait. Honestly, would your wife be doing much else at home than sit if her heart is so bad? I realized there is no point in arguing with crazy so I asked him to wait a moment and had an attending step in. He didn't have any more luck than I did and he made the chief have a talk with the man. In the end, the man came and apologized to my doctor for having been harsh. It obviously wasn't only this man's actions that brought my doctor to tears but rather the whole day. 

Patients need to learn to realize which doctors truly care about them and do their best to treat them and which doctors really don't care if you wait three hours. The doctors that care (and I'll include myself) really put themselves under a lot of stress to help patients as best and as quickly and comfortably for the patient as we can. We aren't sitting at our desks twiddling our thumbs. 

I ended up sewing a finger that day of a lady who almost cut off the bottom side of her finger with a knife.

The rest of the week was better than Monday but still had times a patient congestion. The other doctors in the department were really supportive of my doctor. On Monday, two came down to help us and that gave her a chance to collect herself. The chief said that she should go eat something and that the other two could finish up the last hour of her shift. The attendings offered her to stay out of the ER the next two days. They were all really great but my doctor is a lot like I am when it comes to these episodes of frustration. It gets to a point, we break and then we move on. She didn't need the next days off from the ER, she just needed a few minutes to breathe. Nonetheless, I think its great that she had so much support from her colleagues. I think almost every doctor (that cares) has these moments. 

I sewed up a few more patient during the week. 

Thursday was definitely a little kids day. About 80% of the patients were kids. I ended up just carrying around Berni the Teddy Bear in my scrubs pocket all day. Each kid that comes into the ER and looks like they would enjoy having a teddy bear gets one to take home.

Friday was another fairly busy day. Since it was, I was allowed to take care of a patient almost all by myself. He had cut his lower arm while moving material at work. It was deep enough to sew up and that is what I did. I prepared everything, sewed up, bandaged and wrote the release note all by myself. The only thing I didn't do was the local anesthesia. (That is something I still would like to do the next two weeks.)

I also sewed up a wound on a older man's head after he fell. The options were staples or sutures. I was happy we collectively decided to suture. I personally think the wounds look better with fewer scares and I have something to do. 

The whole week, I was spending my time after work preparing my friends bridal shower. I had planned on a nice picnic by the lake. I had even picked out the tree the week before. The weather forecast predicted rain. Only on Saturday. Not on Friday or Sunday. Just on the one day in the year I plan a picnic. I ended up transforming my itsy-bitsy apartment into an indoor picnic. Everyone was happy and had a good time so I see it as a success! 

Sunday I spent my day at the flea market trying to make some money and reduce the size of my baggage. Always thinking prospectively. In a few months, I have to decide what goes back to the states with me!

Stay healthy!


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