The morning started off with Geriatric Clinic. I don't think I had any patients under the age of 70 for the first couple of hours. Unfortunately, several had to be admitted; mostly because age was finally catching up and their families could not longer care for them at home. We have a lot of admissions for "weakness."
Things started to pick up as the morning progressed, and we started to get the chronics who won't go home. Why do some people want to come to the ED just to sleep? We have several patients who will come in with some random complaint of "nausea and abdominal pain" who get an IV, some medications and then pretty much establish a home base and milk out the stay for hours. They'll be complaining of 10/10 pain even though they've been sleeping for hours, demand more pain medication, and are asleep before the RN can even get back in the room with it. These are the ones who miraculously improve when they are placed in the hallway because a more urgent patient needs the room and, more importantly, the cardiac monitors.
Lunch time arrived and we had a reasonably full house. Chronics sleeping in a few rooms, seniors waiting to be admitted, then the random "waited all weekend and now can't get into the doctor's office because it's a Monday and their schedule is booked" patients come in. There's a flurry of activity as they come in and out almost like a revolving door. Charting takes longer than it actually takes for me to see the patient, do a physical exam and plan for discharge.
The afternoon wears on and I start to dread the "after school" or "after work" rush. School has started and there are sports injuries galore as kids who have sat around all summer start actually doing some physical activity. Then there's the "it's bothered me all weekend, but I had to go to work today and I must be seen now" group. Kinda like the previous group, but employed. Sort of. Or wish they weren't. Like one patient that jammed their finger playing basketball and wanted me to write them for a week off work... really? Listen up 18 year old... you've got a lifetime of work ahead of you, so you better get used to it because you're not getting off to a good start.
Evening comes. The RN's are antsy because they're on their last hour. The flotsam and jetsam of society starts to roll in, and I see the kind of patient I can't stand... the "waste of my time" with the "I demand everything be done" family. Let me get this straight, the police "kicked the &*^% out of you" for being involved in a fight with your pregnant daughter's baby daddy, dragged you to jail where supposedly you got further assaulted. You were released before midnight last night at which point you came to the hospital to see your daughter who was injured in the original fight but were not allowed to see her because police said you were threatening her but during which time you refused to be seen for your "injuries." You then proceeded to "disappear" per your "concerned" family members only to reappear late this afternoon and "collapse on the couch." Family calls 911 to bring you for evaluation so they can "sue those *&^%( police" who did this to you. You refuse to speak to EMS, myself, the RN, and only interact with your family members. When the words "drug screen" are mentioned you suddenly are able to stand and walk and communicate to the extent that you sign out AMA (against medical advice) and storm out of the ED. Meanwhile the "concerned" family members inform you that "don't worry, if he passes out again we can always call EMS." Thanks, that will be an excellent use of resources.
It's end of my shift, and I am waiting for a woman to deliver her baby. This is not a joyous occasion. She's from out of town and things started to go wrong. It's too soon, and the baby is too small, but Nature has already started the process. She keeps asking why it's like labor. I tell her it's because it is labor; her body only knows how to do one thing. After almost an hour it's over. I have to change my scrubs before finally heading home. What a way to end the day.
I drive home mentally reviewing my shift. Did I really help anyone today? Did I display something close to empathy even though some patients really pushed my level of patience? Was there something I should have done that I didn't?
Luckily, self-doubt is all but forgotten as I cross the bridge for home. There's bigger issues to think about... and, lots of distractions to help erase the memories of the day.