Saturday, May 14, 2011
Welcome to My World
I come into the ED in the morning. Usually I have time to run to the cafeteria and grab something to eat; oatmeal, powdered egg special, etc. Sometimes I will stop at Starbuck's on my way in; Caramel Macchiato and a sausage sandwich. The board may be empty, or the early morning Dental Pain will be just getting put into a room. I drink some coffee. Check my leftover dictations. Then I find the strength to go see that first patient.
About this time the first of the Chest Pains or Shortness of Breath will come in the door. They've been dealing with their problem all night long, called the doctor's office this morning who told them to go straight to the ED. So now they're mine. I listen to the story, write basic orders and now these patients are cooking.
People are waking up, soon the kids with fevers, people with abdominal pain, maybe another Chest Pain or two will roll in the door. But still, I am working with maybe just three or four patients. Move the pans around the stove and make some adjustments.
Around 1 p.m. I am thinking about lunch. Should I see that new Abdominal Pain or go grab something to eat? Whoops, should have left because the ambulance is rolling in with Altered Mental Status. That could be anything from an overdose that was just discovered to a possible stroke from the nursing home. I wait on lunch, but the clock is ticking because the cafeteria closes at two, and I still have another 6 hours to go. What to do? What to do?
About this time the busload of patients starts to roll in the door. The Fevers, Abdominal Pains, Abscesses and Rashes start to mix in with the Couldn't See the Doctor in the Office Today So They Sent Me to the ED. There might be a traffic collision. Or maybe a roll-over ATV accident. As the afternoon wears on, so do the traumas. Now Lacerations start to blend in. As doctor's offices close, those that waited for the last week just can't wait one more day. Or the Dental Pains or Back Pains that are looking at one more night without narcotic pain medication start to show up.
The clock watching starts. There's two hours to go and the board is full. The waiting room is starting to fill up. Ambulances are coming and going. I'm wondering how many beds I have left in the hospital. The nurses are getting antsy because they have half an hour to go. Everything seems to go in slow motion. About this time someone gets really sick requiring multiple procedures and everything get delayed that much more.
Then fresh help arrives, but I am trying to plan my escape. I've got a pile of charts to dictate, and I don't want to be here long past my time. There's a bunch of people in the waiting room, but I don't want to get started on work-ups that I then have to sign out. An hour left, and I am only going to see the "Yes, you've got poison oak here's your steroids," or the Crashing as We Speak. Sometimes I will give some basic orders for analgesics or to get lab work started.
Of course, the Law of Karma states that any labs or CT results I've waited two hours for are mysteriously going to be available 10 minutes before the end of my shift. Suddenly I am waiting for call backs on admissions, doing discharges and subsequently dictations on all of my patients while the oncoming doc just starts picking up new patients. Two hours later I am walking out the door.... My goodbye to the overnight doc is, "See you in the morning."