Day 12 - I Hate Everyone

Some days, this is my theme song for work.

When the never-ending stream of patients

keeps coming in the front door so that I can

"make sure this blister isn't infected"

"refill my script for pain pills that my girlfriend stole"

"find out why my side's been hurting for the last 3 months"

or so I can have 15 year old try to scam me for

narcotics for their "slipped disks."

When the chronics come in complaining of "increasing pain"

that is not relieved with their prescribed doses of narcotics and benzos.

And who tell me right off the bat that

"I need more than the usual dose because most medications

don't work on my pain"

&

"oh, by the way, I'm allergic to everything except for dilaudid."

When the borderline patient tells me to "*&^% myself"

as they're being brought in by police and EMS.

Don't yell at me when you're the one who "tried to kill themselves"

by taking an extra dose or two of your medications.

As I stated in a previous post,

if you really meant it, you'd take a LOT more medication.

Who's wasting whose time..?

Ok, let's breathe in with the blue

breathe out with the green...

and drink alcohol,

lots and lots of alcohol...

Day 23 - I Weep For the Future

One of the best lines from the movie "Ferris Bueller's Day Off."



I worked triage over the last couple of days during my ED shifts.  No where can you see the failure of the health care system, and society in my opinion, so readily as on the Front Line of medicine... the Emergency Department triage room.

- patient with three year history of stomach pain who came in because it hurt more the day before while they were driving but they couldn't get a ride to come to the ED until tonight and they came because their mother told them they should have it checked out because there might be something wrong.  Um...

- patient with very high blood pressure can't get needed prescription because insurance won't cover combination med.  Pharmacy has been calling cardiologist for over a week to get new prescription but no one returns their calls.  Insurance will cover meds separately so I write a prescription for them.

 - pregnant patient can't get doctor because they don't have MediCal yet and has to wait to be able to get into a practice that accepts MediCal.  She goes to a free clinic where she can get prenatal vitamins but none of the recommended blood work or other prenatal tests.  She's now almost 5 months' pregnant.

 - patient with kidney stone blocking their ureter gets sent home with scripts for antibiotics and pain medication and told to follow up in urology clinic to have stone removed.  They never get a follow up appointment because they don't have insurance and their MediCal application wasn't filled out because they neglected to do it.  They didn't fill their prescriptions because they "don't have any money to pay for medication."  Crystal meth, alcohol and "pain medication they borrowed from someone else with kidney stones" are what they've been using to help with the pain until tonight when 3 weeks later "the pain is like the first time."

 - patient with gallbladder pain who tells me they "can't just change my diet that easy" and who wants to see if they are "sick enough to have it taken out" because they are "tired of waiting for the referral from my doctor" to see a surgeon to schedule surgery.

 - child brought in with a cold.  They have a "runny nose and are congested."  Do they have a fever? "No."  Are they eating/drinking/peeing/pooping normally? "Yes."  What are you concerned about? "Well, I wanted them checked out."  Did you call your pediatrician? "Yeah, but they can't see them until Monday, and I didn't want to wait."

 - patient with chronic pain who was upset that they had to change doctors and insurance because of the ACA (affordable care act) and who now can't get the pain medication they were used to because it is no longer on their insurance formulary.  "Can you write me a script for it?"  Are you going to pay out of pocket for it?  "No, I don't have any money." Um...



**please read my disclaimer that these views are my own and do not reflect the medical groups for whom I work nor the professional organizations with which I am affiliated.

#575 - F is for Frenetic

Momma told me there'd be days like this...

Here's an example of the kind of day I DON'T like to have in the E.D...

My shift started at 0800, there were already 5 patients on the board,

4 of which my colleague signed out to me waiting for lab or xray results.

The patients I saw today:

 - patient who swallowed an entire bottle of herbal supplement after confusing it with a bottle of 5 Hour Energy Drink

 - leg pain for a week, worse today

 - I Didn't Know I was Pregnant show candidate who came in about 7 months pregnant and using meth

- patient with facial lac after a fall out of their wheelchair

- psych patient off their meds who ran out the door twice, and brought back by police once

- patient who passed out while getting out of their trailer

 - strep throat

- skin infection

- patient who passed out while doing chair exercises with their senior group

 - asthma attack

 - migraine headache

- hair coloring on beard gone awry

- dental infection

- alcohol intoxication, passed out in front of the local market

- cough for several months

- chronic headache who could only be treated with demerol which we haven't had in the ED for years

- tick bite brought in because "we didn't get it all out"

- end of life hospice patient

- patient who was second in line to be seen, but left because after waiting 30 minutes they couldn't wait any longer for the CT they knew "they just had to have" for the belly pain that had been going on for several weeks

- appendicitis

- eye irritation

- panic attack

- alcohol intoxication hit in head by spouse with head laceration that then cussed us out and ran out the door

- skin infection

- febrile illness in transplant patient

I left out identifiers like sex... the pregnant person you can figure out.

I left out much of some of the back story because this is a small town

after all, and everyone knows everyone's business as it is...

These all came in within a 12 hours period and kept my ED busy

the entire time...

Let's now even talk about how many charts I have yet to do...

Waiting for Tonight

I often wonder what makes a person come into the emergency department with a non-emergency.  Especially when they have a problem that's been going on for more than, oh, 6 months... a year... 3 years.  And, I doubly wonder about them when they tell me that they've actually been seeing their doctor on a regular basis and never brought it up... not once... not ever... didn't think it was important.  Until today, more often, tonight.  And, can you please fix it and make it go away?

Now, my mother would often say, "Those doctors don't know anything.  They just want your money and to give you pills."  That, of course, was before I went to medical school.  Afterward, when she would complain to me about a chronic problem, I would ask her if she had told her doctor about it.  Her answer, "Well, that's what I have you now for."  And for, I suppose, all the other patients that come into the E.D.

But, seriously, what was it about today... tonight... that suddenly made it worse?  Come on... tell me... you know that I am not going to be able to fix you.  Because if your primary care doctor who has all the time in the world and a heck of a lot more resources can't figure out what is wrong with you, then how do you expect me, the lowly E.D. doc who has maybe five minutes to spend with you amoungst the maelstorm of humanity, and who doesn't know anything about your background, your meds, your allergies, your homelife, your mother's maiden name or the name of the boy you kissed in the fifth grade to fix you today... tonight...?

Please tell me...