#1672 - On Jumbled Mess

The last three days at work have felt like a Jumbled mess all right.

I usually like to get into a flow of sorts at work.

Patient comes in, gets seen, get the workup started,

move onto the next patient.

But, it's been more like:

Four patients waiting in the rooms when I arrive.

Three are old from the prior shift waiting for studies, and one is new.

See the new one and get things going.  Then another new one gets put in.

Try to see the new one while one of the old ones screams that 

they are ready to leave.  The new one needs nothing done and 

can be discharged.  Now two new ones are put into rooms,

and I get called quickly into a room because one of them is really

sick and needs attention yesterday.

Trying to put in orders on the new sick one, while trying to write discharges

on the old and new one, when another old one is ready to go

and the third old one turns out to be sicker than thought

and now needs more orders and a consult.

Get orders in on the sickest new one, haven't seen the other new one,

but then another new one gets placed into a room,

and, oh yeah, the PA didn't show up and there's

four other patients waiting to be seen in Fast Track.

I send my medical student to go see the "stitches removal"

because that should be easy, right?

While I discharge three, try to admit one, finally see another

and put in orders, the medical student comes back saying

that "something doesn't look right."

Now it's leave my work area and go to look at a wound in Fast Track.

Reassure patient and medical student that everything is ok,

and look at two of the three other patients that are there.

They're ready for discharge, so I grab their charts, remove the stitches

from the original patient, and grab their chart as well.

Stack of charts in hand, I go back to my work area to 

find that the nurses have roomed another two patients to replace the ones

I discharged, plus my sick patient is ready for admission,

and, oh by the way, a STEMI is on the way in and

will be in the ED in 3 - 5.

How many more hours until my shift ends....?

2013 A to Z Challenge Post:

J is for Jeep

Day 17 - A Cut Above

I spend a lot of time suturing in the E.D.

Usually I like to pull these patients back right away so I can get started on them, 

because I know that I'm going to be with them for a while.

Recently, despite an earlier post, I've started playing music while I suture.

Closing music.

Most patients say that it helps them to relax.  I wonder if I could write off my SiriusXM subscription

since I always ask the patient what their favorite music is.

I've had requests for country, and 40's.

Rock, disco and blues.

And, I've found you can't always predict what someone likes to listen to.

Recently, I had an ill-dressed, grumpy 60ish patient who cut his head on a door and had two serious lacerations that I had to repair.  He'd been surly to the nurses, and answered all of my questions roughly and with as few words as possible.

I gathered my supplies and brought my iPhone into the room.  I asked if he would like to listen to some music while I sewed.  He looked at me, and gruffly told me that I wouldn't have his favorite music available.  I assured him that I could play anything.  He responded with, "I like classical music.  Do you have any of that?"

Looking him square in the eye, I asked him, "symphony or pops?"  He held my gaze for a just a beat and then smiled.  "Symphony of course."

While I set up to suture him, he was silent for a moment and then stated, "guess, you wouldn't think someone like me would listen to classical music."  I assured him that I never made assumptions about people.  He then went on to talk about his love of Western movies as a kid and how the background music was classical music.  That's where his love of classical music grew.

We listened to Brahms while I closed his laceration.  For a few moments, we left the E.D. and were transported to a more gentile time.  When men tipped their hats to women, fought for their honor, and rode their horses into the sunset.... Not a bad way to spend part of my day... 

Fly on the Wall

At this point in my career, I don't know how many people I've sutured.  Between working as a surgical resident and being an ED resident then attending, I've done a LOT of sewing.  In surgery, I had "closing music."  That music that plays in the background while you methodically close all of the layers of tissue you had previously opened.  I daresay suturing becomes sort of mindless after a while, so you enjoy the right brain entertainment.

You don't get that in Emergency Medicine mostly because it's already a noisy, chaotic place and music would just be a distraction, but sometimes... sometimes you have an evening like tonight where I had a long complex ear laceration repair involving multiple layers and almost plastic surgeon-like skills, and there were no other patients in the department.  Tonight we pulled out the Frank Sinatra (it was a senior citizen after all) and jammed to "I Get a Kick Out of You" while I made his ear look like an ear instead of the congealed mass of torn flesh and cartilage.

Other times, though, music is not needed as you simply seem to disappear into the background while the patient and their spouse/significant other/sibling/parent/entourage provide running commentary and/or simply talk about personal matters while you quietly sew together their torn skin.

I've been privy to family dramas, dates gone wrong, girls gone wild, etc.  Drunks don't seem to care who hears about their adventures on the bar scene, while some some have felt perfectly comfortable talking about sex and STD dramas while I'm sewing.  I've heard about impending divorces, ex-spouse love triangles, and teen angst escapades.  I know people's vacation plans, baby plans, wedding plans, and tattoo plans.

I always thought CO's weren't supposed to talk about their lives in front of their prisoners, but I was always amazed at the amount of information they shared while standing around waiting for me to finish. I learned about promotions, who was leaving, who was coming on, what their kids were doing, medical problems, etc.

Then, there's the solo patient who comes in.  Usually elderly.  It's amazing how you can hear someone's life story in just about half an hour.  You learn about dairy farming, lumberjacking, airplane flying, etc.  You know how many children, grandchildren, great-grandchildren they have.  You hear about the places they have traveled.  And, sometimes you just sit in awe of the life they've lived.

Of course, eventually I start to wish again I could have closing music in the E.D., or even be allowed to wear headphones while I suture....  Come, on, Blue Eyes, sing me another....