Sunday, October 24, 2010
Full Moon, Saturday Night...
I came on shift last night to a full board, a child continuously crying, a patient in the corner room yelling out, "Nurse! Doctor! I need something for my pain!" and a bevy of police officers. Looking around, I put my stuff down in our work area and started picking up charts to see patients.
The Screamer is a regular who comes in demanding narcotics and has a "pain specialist" that prescribes a large quantity of pain medications on a regular basis. So, I don't quickly rush into that room. I go see a patient with an injured shoulder.
The crying child got into some of her grandmother's medication and is sitting around waiting to see if she has any lasting effects. She's screaming because she's been in the E.D. for 2 hours... and has 2 more hours to go. We'll see if her lungs last that long... or our ears.
A radio call comes out that there's been a rollover accident on the highway 30 miles south of us... three injured. They'll be at our doors in about an hour. I haven't even been in the E.D. for an hour.
My colleague who worked the day shift signs out her one patient... who's supposed to go home. However, the patient's heart decides to go into an irregular rhythm which means more tests and an admission for me on a patient I really don't know a lot about. But, ok. I have a patient who shot off part of their finger; which explains the police presence. I go see them.
The Screamer starts to yell in a more fevered pitch, and the RN takes a call from the Screamer's Spouse demanding to know why we haven't treated their spouse. I sigh looking at the still-full board and waiting room and walk into the room. To say that things did not progress well is an understatement.
The Rollover Trio arrive. They are supposed to be evaluated for their traumas. They are all gone within half an hour. The E.D. staff and the arrival of law enforcement forces them to answer a lot of questions they don't want to. So they all disappear. One with what I could guess is a broken arm based on my fleeting vision of them as they made their way out of the E.D.
The Child is still screaming and the Screamer wants more of anything we are willing to give them. I deal with a tooth abscess on a patient with bad teeth, who's a smoker who has a history of heroin abuse. Then another abscess on a patient visiting family in the area. And a child who dropped a rock on their foot and broke a bone.
The Screamer's decided they have had some relief with the non-narcotic cocktail I gave them, and they leave. I check out the Child and get them going. The E.D. is emptying out. I sew together the cheek of a patient who fell while riding their motorbike, and then I finally finish treating the missing finger part.
Around this time I get a child who is very ill and who will tie up most of the rest of my shift. I see a patient who thinks they got broken ribs from a tight hug, and another who was seen six hours before at our sister hospital who thinks their rash was getting worse. I spend my last hour dictating the charts from the night, and a few I had left over from my previous shift.
Morning comes, and my relief comes.... I sign out my sick child who is waiting for transport to another hospital and go home. I think those studies are trumped by anecdotal evidence.