The Final Countdown - Day 4 of 5

I'm Dr. B, and welcome to my world.

So, the challenge continued. In just about a week's time, I've gone from fun-loving, cool ED doc to expected specialist in epidemiology, infection control, risk stratifier, and it's gotten to the point I've actually started keeping up with the medical literature on a daily basis just so I can have the latest information about this whole thing... it's becoming very stressful, and I am so glad that I only have one more day of this before I take a long six week hiatus. Hopefully, on the other end of that, this will have been a true learning experience for all of us.

You don't think about illness much when you become a doctor. I mean in terms of what can happen to you. Sure, you're careful to avoid needle sticks. Work place violence has become more prominent. You know when cold and flu season starts, you'll inevitably get coughed on by that 2 year old just as you lean in to listen to their heart, and BAM! about a week later you're coughing with a runny nose... or worse, what we used to call in residency "the pedi flu" which you'd always get during that first week of your rotation back at Children's Hospital and which had you running to the bathroom for one thing or another. That was the worse.

But in terms of being scared about something, I don't think we are. At least, I can't think of anyone on my staff that would back down in the face of an epidemic, or pandemic, or whatever is before us at the time. We come to work, we gown up, and get to moving. We help each other. We support each other. We work together.

And, that was always the draw for me when it came to Emergency Medicine. While I loved the challenge and instant gratification of surgery, it felt more like a soloist instead of a chorus. We may squawk and balk at each other from time to time, but when there's a code, when there's a patient in need, when there's a catastrophe of any kind, the team pulls together to make things happen.

One of the best compliments I ever got from an RN was that they would "always be glad to follow me over any hill." You always think about the doctor sort of running the show, but there's a difference between a director and a leader. The director tells you what to do, while the leader shows you what to do by their example. My codes are generally calm and not chaotic. I listen when the nurses tell me their concerns about their patients because they're the ones spending more time with them. I take the time to teach whenever I can so that we always know and understand what we're doing together...

Like today... I electrocardioverted (shocked) someone out of an irregular rhythm. I diagnosed two people with abscesses and infections (one got to go home, the other had to stay for a more serious infection), I saw my meth patient back again for a dressing change and antibiotics (they actually looked like they'd showered and had done a bit of grooming), I saw and worked up and discharged two chest pains, I dealt with a patient who seemed to want to have something wrong with them (they stated they'd been having abdominal pains for "years" and had just seen their doctor 2 days ago after which they went to the another ED where they got a full work-up and evaluation, then came to my ED because they wanted a "second opinion, I reviewed everything from the prior ED, went over their results, and every time they brought up a new complaint - abdominal pain became chest pain became "are you sure I don't have a tumor" which I reassured them they didn't because the CT scan would have shown it, and I had worked up their chest pain because that had been their initial complaint at triage even though they told me they'd come in for abdominal pain, I referred them back to their PCP and to GI for evaluation of their multiple complaints), I had the drunk that had to sober up,  I had the drunk that was sobering up and going into DT's, I had the singing psychotic decide suddenly that clothing was optional and wanted to run around the department showing this to everyone, and I had a couple of patients that required me to put on my new body armor and go into the big scary tent... now I have to check my temperature every couple of hours, but I'll still be back to work tomorrow for that last day at this hospital... then I'll self quarantine, sort of, for the next several weeks... 

The Final Countdown - Day 1 of 5

So about 9 years, 5 months and a week ago I started as an attending

at a small hospital in Northern California.

This is how it went.

Today I started the last of 5 shifts that I will be working

at the slightly bigger sister hospital.

This is how today went:

cardiac arrest came in, after about 30 minutes of CPR and putting in a breathing tube

we got back pulses... then I had to stop the ventilator because we found out the patient had a DNR (do not resuscitate) and the family member let us know that they had wished to not have anything done,

so that was a little frustrating

during that time, a patient came in with a really low blood pressure and fast heart beat,

hung some IVF and some pressor medications and got them under control,

admission to the ICU

then I had to clean up the mass of patients that had come in while I was working on the cardiac arrest and patient with low heart beat

they included:

  - a chronic drunk who was drunk again and needed a room to sleep it off

 - poison oak allergic reaction

 - patient with shingles

 - patient with problem with their ostomy

 - a chronic meth user that left the hospital to smoke meth and was now returning

because their infected foot somehow did not magically get better without 

antibiotics and wound care, not to mention running on it barefoot in the woods

while high on meth

 - an elderly couple both with dementia that went on a joy ride and ended up driving down

an embankment

- a patient who passed out and hit their head and who could now not move their leg

AND

I had to manage the patients signed out to me by my colleague in the morning

which included:

- an appy

 - a pregnant appy

- a car crash victim with abnormal vitals

and a couple of people who didn't like their lives any more

so needed psychiatric help 

AND

in the midst of all this a code was called on the hospital floor

and I had to run upstairs and put a breathing tube in that patient

while they were doing CPR...

... the patient later coded again in the ICU and didn't make it...

AND

not to mention a lot of phone calls where we had to triage and decide

which patients actually needed COVID testing... OMG

The one bright spot in my day was a visit from a patient

who'd had a serious brain infection which had to be transferred down to 

the big city children's hospital where they underwent

brain, eye and sinus surgery,

IV antibiotics,

physical therapy to help them be able to walk and move

their right side again

and here they are a month later looking

bright and a lot healthier than the day I saw them...

this is them:

I hope he does amazing things... 

*photo posted with permission*

November Notes, Day 23

"Anywhere But Here"

I caught a cold.  Workplace hazard.  I wash my hands like crazy, 

but it doesn't help when a viral-laden pedi coughs in your face

when you're doing the throat exam or looking in their ears. 

I tell their parents to keep them home, rest, lots of fluids,

follow up with their pediatrician in a couple of days if they're

not getting better... 

And, yet, I can't call in sick and follow my own advice.  

I have to go to work.

After all, those Norco scripts aren't going to write themselves...

And For My Next Trick...

Every once in a while I do a procedure in the emergency room that isn't done very often.  Every once in a while I do a procedure while there are nursing and paramedic students around.  And, every once in a while I do a procedure that isn't done very often while there are students around.  Like today.  Today I drained a knee.

Now, we do knee "taps" not infrequently in the emergency department, but it's unusual to do one on a pedi.  That's pronounced pee-dee... as in pee-dee-atric patient.  Not peh-dee as in peh-dee-cure.  Anyway, we get sick pedis every once in a while, and tonight I got a small patient with a big knee that needed to be tapped.  And, I had a nursing trainee and a paramedic student en tow.  Throw in mom and little sister, and I had quite the audience.

I don't mind performing under pressure.  Heck, I'm an E.D. doc, and I do it all the time.  Add an audience, and it just adds to the fun.  I remember as a surgical resident sitting in report looking at chest films and hearing the intern say that one of the patients was suddenly short of breath and with a fast heart rate.  He thought he might just be in pain.  I took a look at the chest x-ray and quickly realized the patient had a collapsed lung and might be developing a potentially lethal complication called a tension pneumothorax.

I called out my suspician to the trauma team, and we rushed out of our conference room en masse to the patient's bedside.  I had my senior resident, the attending and about 3 interns plus several medical students all rushing around gathering supplies.  I was given the job to put in the chest tube since I was the junior resident and responsible for this.  Now that was pressure.

Tonight, not so much... but still, you have to get used to working under a spotlight sometimes.