Sunday, October 24, 2010

Full Moon, Saturday Night...

There have actually been medical studies performed to disprove the notion that E.D.'s become more crowded on Full Moons.  However, ask any E.D. physician or nurse, and they will tell you that the crazies do seem to come around more during the full moon.  Add a busy Saturday night, and it's a recipe for complete chaos.... if you're the superstitious sort.  Which I am... I'll let you be the judge.

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.

Monday, October 18, 2010

Monday Deja Vu

There something about Mondays in an Emergency Department.  I don't know what it is, but Monday was the one day of the week we all dreaded.  Especially at Buffalo General.  My first blog post at The Central Line was about Mondays.  It's just an evil day.

I moved to a place where I was supposed to just see grannies with urinary tract infections.  I wasn't supposed to come in, on a half day shift no less, and see a full board, with a full waiting room and deal with:

 - had big log fall on me - patient works with a lumber company and had a huge log fall on leg and trap it until they were able to saw it away.  He had a knee strain but I was worried about damage and swelling in the muscles of his leg.  Luckily, everything turned out ok.

 - vomiting blood - patient with liver disease who came in bleeding from both ends.  A tube in their nose put out over a liter (1/3 of a gallon) of bloody stuff within the first 5 minutes it was in.  Not to mention they had a broken nose because a "friend" assaulted them when they were drunk.  They got a central line and transferred to the city hospital.

 - heart attack - patient who came in complaining their lungs felt heavy who I initially dismissed but then decided to get labs and an EKG on.  They were getting tired of waiting, and I was able to convince them to stay by feeding them.  They were going to be admitted to the city hospital.

 - stroke - patient had been goofy all day and family finally decided to bring them in that evening.  They were going to be transferred when I left.

 - bleeding into leg - 90+ who'd recently had surgery and was now anemic from probable blood loss into their leg.  They were white as a ghost.  He came in complaining of an upset stomach.

 - and a whole mess of other small things I ran in and evaluated quickly in between these patients.... wow.  I saw almost as many patients in my six hour shift as I usually see in a twelve hour shift.  Just some jam-packed Monday fun...

Thursday, October 14, 2010

A Day at the Beach

 Yep, you can drive right down to the shoreline... no problem with 4-wheel drive...

  Lots of trees and branches washed up on shore...

A rock..?  No, it's actually part of a large tree stump that washed up on the beach after having been submerged for a long time... you could see barnacles and shells from other sea life on it.

  I love the ocean... I love the Pacific... 

Now I've got a front row seat...

One of my hubby's friends has an even better seat, though!

Saturday, October 9, 2010

Give Me Liberty... and I Will Go Everywhere!

I love my Jeep... it's been with me since Chicago and graduation from medical school.  It's traveled from there to Boston.  Back West to Minnesota.  Back East to New York.  And, it has now made it's way West to California.  In fact, we unloaded the Jeep to drive to my mom's house during one of our stops, and I found it very surreal to be driving my Jeep around my hometown.

Now it's up in Northern California, and we are still going on adventures.  I've had the last three days off, and yesterday we took the Thirty Mile Drive to a small town named Petrolia.

Now, most of the drive is along a small, almost single lane highway that takes you from sea level up through pine forests, across pastures, back down to sea level, past rivers, and into broadleaf forests.  But, being the adventurous sorts and loving that I have a Jeep we had to take the not well-traveled path which one of the local storekeepers in Petrolia told us would be worth our while exploring... this should have been our first sign that things might get rough...

However, we pushed forward through pine trees that touched the sides of the car until we came to this...

If you look every closely around the middle of the picture you can see a truck that made the journey before us.  You can sort of make out the road we were going to have to go down... and down we did...
Which allowed us to see this area...

And take pictures like this...

No wonder it's called the Lost Coast... But, with my Jeep, it was an easy find!

Cheers!  As we continue to explore our new place called home...!

Tuesday, October 5, 2010

What a Day it Has Been

So today I worked my first day as an attending.... all alone in the E.D.  I kind of suspected it would be difficult.  Mostly, I was just missing the camaraderie;  working with the attendings and junior residents.  Having someone to bounce ideas off of.  Some to fall back on when I am uncertain about what to do next.

Primum non nocere - first, do no harm.  That became my mantra today as I negotiated my way through what I felt was a sea of patients.  Not many by some of my colleagues' standards, but it certainly seemed like a lot to me.

I had one sign-out from the prior ED Doc at the beginning of my shift that turned out to be a broken hand in a teenager who fell rollerskating.  I splinted that one, and that's how my day began.

Some of my other patients:
 - lost control of car while rubbing eye.  Concussion and lots of bruising.  My first trauma.
 - fell and got a "blood blister" under fingernail.  Subungal hematoma which I got to drain while burning a hole in the fingernail.  Cool stuff
 - abdominal wall abscess.  Got to show my new nurses how we do VessiLoops in the E.D.  Not to mention draining an abscess.  Very satisfying as always
 - wound check.  Nothing exciting, just a follow-up but important nonetheless
 - rubbed eye so hard they bruised their eyelid.  Did a complete work-up to check for bleeding problems. Nada.  Will have to try to figure that one out with their primary doc
 - slipped on stairs and has a bruised coccyx.  Yes, you can bruise it.  Ouch.
 - fell asleep at wheel and crashed car.  Mild head bonk.  Not a trauma.
 - didn't take medications and now fluid overloaded.  Take the fluid off and send to primary's office where they already had an appointment today
 - fell on tree roots and cut head.  Staples and a turban head wrap.
 - ran over "tree part" that fell off logging truck and now having back spasms.  A little muscle relaxer and some time off work should have you better in no time.
 - I only stopped smoking because now I can't breath.  Double pneumonia will do that to you.  So stop smoking.  And, here's your antibiotics.

Just a flavoring of the patients I saw today.  Back to work tomorrow.  At least I think I will feel somewhat more on top of things.  Got to get my rhythm going and get with the "flow" of the department.  It'll happen... 

Sunday, October 3, 2010

Apple Core... Who's it For?

One of the fun things we did this weekend was check out the annual Apple Harvest Festival.  

Seems some people arrived in the area after the Civil War and planted an orchard of apple trees.  Those same trees have survived and are still producing apples.  

  I love apples, and I especially love this time of year with the weather changing and those crisp juicy apples just ready for the eating!

I have to admit we bought a flat of a variety of apples, and I can't wait to start making all kinds of yummy things!  Here are some pics from the festival located right on Main Street... Lots of good food and some great music!

And, it wouldn't be apple season without some tarty apple cider...

Friday, October 1, 2010

Not Leavin' It in Las Vegas

So, for the last week I have been at the American College of Emergency Physicians' annual conference, or Scientific Assembly, in Las Vegas.  It was, as always, a very interesting and educational experience.

One of the things I enjoy most about the conference is hearing other EM physicians' war stories and realizing that no matter where you practice, the patients are still the same.  While we don't have some of the inner city gang violence that LAC-USC encounters, we still face a lot of the same homeless and chemically-dependent patients.

Some of the other patients we all seem to share:

 - the "I don't smoke in the house" parents who can't understand how their kids have been coughing non-stop over the last two days at home, but who miraculously improve once they're in the E.D.  Or, why their kids seem to have so many ear and upper respiratory infections.  Or, why is Johnny's asthma so bad.

 - the "I know I'm having a heart attack right now, but I need to leave to take care of business" patient

 - the "I don't understand why my kid is so fat when all he does is drink two liter bottles of Coke a day even though he's two"

 - the "I know I called the ambulance because I was really worried about my vaginal discharge, but now that I'm here I just want to leave and what do you mean you need to do a pelvic?"

I could go on and on... but I'll leave those for future blog entries as I get to learn all about my patient population in the new place I am calling home... until then, the things I learned this year in Vegas in terms of patient care are definitely not staying in Vegas... however, regarding my encounter with CarrotTop, well.....

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