Paramedics and ambulance officers are highly trained professionals. They cannot take you home after you have been cleared medically.
If you haven't tried basic analgesia for your pain, you are unlikely to get opioids as soon as you walk in the door.
To the lady who came in after all of her medicine had been lost when her bag was stolen - we were perfectly happy to give you the pills you needed to tide you over. Unfortunately glucosamine and fish oil aren't usually stocked by emergency departments, but for everything else we were very happy in assisting you to keep your serious and complex medical issues under control.
When you bring 5 relatives with you, it is appreciated if the able bodied ones help me fetch chairs for you to sit on. If things are busy, you won't all be able to sit. Department guidelines actually state that you may have 1 relative with you with the discretion of emergency staff.
To the concerned parents who bought their child in fearing a severe allergic reaction: we were perfectly happy to see your child. Your concern is understandable given that the child's father gets anaphylaxis to the same nut. Please don't feel bad because your fears were unfounded. We would much rather rule it out than deal with it at 1am on a Tuesday (or any time of any day).
If the nurses have not yet hung up a drip on your diabetic partner who is horrifically hyperglycaemic (for the 7th time this year) because they are busy with more urgent emergencies, complaining to the medical student about them because you "need to go home soon" is not the way to go.
Complaining that "a person has to be dying to be seen around here" when you have been waiting for 1 hour about your 24 hour flu will not make us stop doing CPR and placing central lines on the patient who is currently being seen. Put it this way...be glad that you aren't sick enough to be seen right away. We will get to you when triage allows.
To the patient with end stage disease who presented late one Wednesday night. I saw the sorrow of the staff who know you well, when they heard you had been taken off the transplant list. It was our privilege to look after you.
If you have presented concerned about your vomiting and possible loss of appetite and marginally decreased fluid intake and refuse to have IV fluids because you don't like needles.....we will wonder why exactly you came to hospital (just not out aloud).
If your partner tells us that she used to be an IV drug addict and she recommends that I try the vein on the other arm instead....I actually do appreciate her help. And I wanted to say "congratulations on staying off" to her but was distracted by the demented gentleman in the next cubicle pulling out his equally demented wife's IV cannula. Props to her! And she was right about the vein, it was a beautiful one.
If you bring your child to emergency because you are concerned that he may be critically ill....ignoring the medical student (who is doing the job of a junior doctor) while you instead discuss the latest doings of Dora the Explorer, while she attempts to ascertain just how critically ill your child is....you will cause frustration.
If you came in drug seeking, I really did not want to just "give you morphine until [you] go [goes] away", but am only a medical student, so the final decision was not mine. I am sorry for that, even though the morphine was what you wanted (though not what you needed).
When I told you that smoking was bad for you and that you should stop, I was deadly serious. As a 30 year old overweight diabetic who has already had to have cataract surgery, I am concerned that your foot will drop off before you turn 40.
When I said that there are better ways to relax than ganja, I was not saying that because I'm a fun-killing wowser. The man in the cubicle next to yours who is telling the psych registrar that his television talks to him is not relaxed.
To the veteran who came in 3 weeks ago with gastroenteritis, we really enjoyed hearing your stories. It brightened up a fairly dreary night. The fact that your wife dropped in a home made slice for us the next day was hugely appreciated, though unexpected.
I don't want thanks for the fact that I didn't get my lunch while I was looking after your wife, it was my pleasure. What was not my pleasure however were the dirty comments you sent my way. Even if they were just joking, a dirty old man is never appreciated. Particularly when your wife is having a heart attack. There are better ways to express your worry.
I really wished that we didn't have to move cubicles 3 times while you were telling me about your miscarriages, unfortunately higher category emergencies came in. You would have been waiting a lot longer in the waiting room if I hadn't have picked up your file at a time when all the doctors were busy, and though that meant that you had to keep moving in your uncomfortable (and grieving) state, it did mean that you were able to be seen faster.
Dear nurse: The reason that I wanted to get an orderly to do a run to pathology with my blood samples was not because I am a lazy, entitled medical student. It was because I was at that time snowed under with patients and had missed the previous blood run. The photophobic lass needed VERY careful checking for a rash, and the young man with abdominal pain suddenly declared himself suicidal and tried to self discharge. Then there was my chap with the bowel obstruction who had the most hideously complicated history known to mankind which the medical registrar wanted to know about before he would review, and the otherwise well but crying baby whose mother was frantic with the thought of meningococcal meningitis.
I love cantankerous old ladies. When you told me in no uncertain terms to state in your medical file that you were "not pregnant", that made my day. I suspect that anyone doing an audit of my notes will consider me an idiot, but I can live with that.
We have seen foreign objects in rectums before. Ours is not to judge. But seriously, that long winded explanation of how it got in there......just own up and say "yes, I do that sort of thing". You and I both know that you didn't just "fall". And please be careful in future, unless you want to invent "bowel cancer" as a reason for your colostomy.
To the man from last Wednesday, yours was one of the most impressive abscesses I have ever seen in a non-diabetic, non-third world situation. How you managed to go about your life with that on your buttock for 3 months is beyond me. Being able to incise and drain it did make our day though. Sorry that the smell made you faint. You will feel better soon. The light in the registrars eyes when he first saw it made my day, honestly it did.
To John Doe who came in one Friday morning. We are sorry that your wishes in regards to end of life measures were not followed, futile though those measures were. It wasn't until several hours later that we discovered you wished to go peacefully. We had suspected this, as you looked like you had been sick for a long time. Though you had gone when we met you, we wouldn't have put your body through that if there had been any way to know.
Yes, I will hold your sick baby while you go outside for a smoke.
To the married couple of 55 years who held hands as I sutured your husbands lacerated shin: you two made my week. In a dignified and beautiful way, your love and passion for each other lit up the room.
25 comentarios:
Lovely post. Thank you!
That was an excellent summing up of real life in the ER and beautifully written too.
btw, Dr Carter (Noah Wyle, I think)doesn't look a day older than in Series 1. I haven't seen it in years.
great post!
Sarcasm is my favorite! lol! Just stumbled onto your blog and enjoyed the laugh :-)
Great post as always :)
Dear nurse: The reason that I wanted to get an orderly to do a run to pathology with my blood samples was not because I am a lazy, entitled medical student. It was because I was at that time seeing more patients than any of the residents or registrars, and they all needed my attention.
Wow - attitude, much? Really - not cool. You don't need to make yourself sound integral to the running of the department. You might be "seeing" more patients than the registrars and residents, but you are not yet as useful as they are.
BeachBum, caligirl, tasha k, Polly: Thanks for your comments!
Elaine: Thanks! I agree with you about Noah Wyle (though am not a fan of his character).
Anonymous: Wow, thanks for being my first ever nasty commenter. I never implied that I was more useful than anyone (and wouldn't), as for the medical student being integral to the running of a department, all I can say is that that department would crunch to a halt rather quickly. What sometimes happens in ED is that someone can discharge all of their patients and then spend an hour or so waiting for anyone new to be triaged (which is what had happened with all the doctors, a sign of their efficiency), and things can turn from quiet to insanity in minutes (and vice versa). I was slightly snowed under as (under the name of a senior doctor) I was seeing about 5 patients and a few of them deteriorated. And not giving any of them attention would have been unprofessional and dangerous. The lab is a fair walk away, which is why it is standard practice for an orderly to do ALL path runs. The case was that that night I couldn't find an orderly and the nurse I spoke to hadn't seen how snowed under I was. I am certainly not as useful as a doctor, but am still (under supervision) doing work that a doctor does. Which is one of the reasons I love doing placements in the emergency department so much.
To be honest, the comment wasn't meant to be nasty - apologies - night shift makes me snappy. Your entry simply struck me as being a tad disrespectful to the doctors and nurses who teach and supervise you. I full well know how EDs work, having worked in many before. I also teach a lot of med students who think they are indispensable - and believe me, I've never worked in a department (ED or otherwise) which would grind to a halt if the med student didn't turn up. Whilst useful, even the most talented, bright and keen med student is a burden (in the nicest possible way) to the staff who supervise them. You'll see this when you start working - you'll be one hundred times more useful once an intern with some exponential learning under your belt than you are now. But, for now, it's a little out of place to compare the work you do to that of doctors. With the risk of sounding pedantic, you're not "doing the work of a junior doctor" - you're doing the job of a medical student - there is a huge difference there. It sounds as though you are doing it well, BTW - but still, you've got a way to go until you're truly an essential cog of the machine.
The huge difference being the "under supervision" of a senior doctor, who makes final decisions and signs off on drug orders and investigations. I reiterate my complete lack of thinking that I am indispensable and my complete lack of thinking I am some sort of essential cog. The original blog paragraph which you took exception to was merely a comment on how I was unable to do a certain aspect of ordering a test while very busy, as opposed to radiology requests which even the head of the department takes around himself because it is so much closer.
Speaking of nurses and medical students, I've noticed that OR scrub nurses can be unnecessarily mean to med students for no apparent reason. Maybe i've just had a run of bad luck in my OR experiences.
The difference is more than just the level of supervision needed. It's the clinical experience and judgement between a JMO and a med student which is so huge. Our interns aren't allowed to call a team for a consult or make a clinical move until their patient has been vetted by a senior colleague. In that respect, the idea of having a student - even a good one - picking up patients and not being able to leave their side for fear of the patient deteriorating further is kind of scary, to be frank. If a patient (or patients, pleural) is that sick, they should be seen by a doctor, not a med student. I know staffing in some EDs is dire, but I would worry if it has come to that...
Retrospectively, I think the whole tone of your post, rather than just the snippet I quoted, got me bristling in a post-nights haze. You write as though you have been working in busy EDs for years - with cynicism that most of us inherit through bitter experience. It is just unusual for a med student to write from that perspective - I actually had to double check your user info to confirm that yes, you are still a student, and not yet working as a JMO.
Anon: Again "under supervision". Not calling consults unvetted or otherwise.
Kevin: Its a shame you had that experience. Sometimes as the lowest on the hospital food chain we can be the first to cop it when people are under pressure. Sometimes this is in places where there is traditionally friction between doctors and nurses (some people have this experience with midwives). Its a shame. In all the EDs I have ever been in the order of the day has been team work so is a lot more med student friendly.
(refreshed after sleep)
Yep, yep - I get the "under supervision" bit. I supervise med students and JMOs alike on a daily basis - so you're preaching to the choir. Let me put it another way. Imagine you or one of your family had symptoms suspicious of meningococcaemia. Would you not think it a little worrying that the first (and seemingly, main) point of contact you have with the ED is with a medical student? Even if they're working "under supervision", wouldn't you expect a doctor would be involved pretty early and fundamentally in the piece, particularly when the patient is looking really crook?
Regardless, no matter. It sounds as though you are elbows deep in ED goodness - it is a good thing to see a med student getting a good run in that rotation for once. Many of the tertiary level EDs don't have any time for students, which invariably culminates in bad student rotations, so it is refreshing to hear positivity for once!
I would think it worrying myself. However this was not the case. Again, just a comment about a small aspect of a very busy evening (where I found myself overstretched and possibly should have not picked up extra patients even when everything seemed relatively under control prior to that), not a blow by blow account of every aspect of patient management.
Excellent post.
I always find it interesting that people that make nasty comments are so brave as to remain 'anonymous'.
This anonymous was indeed being nasty and catish as far as I'm concerned, but I'm assuming it is from America and that explains its ignorance. And its the one with a huge attitude here, not you. In our setting and I'm assuming in yours as well from what comes across in your blog, most med students are highly trained and indeed an integral part of any department and do in fact do the work of a junior doctor. They have excellent clinical knowledge and skills and the difference between med student and junior doctor is not that great. In America, it is a big difference though so that is probably why anonymous is being so aggressive towards you. Don't let it get to you.
Loved this post!
"Yes, I will hold your sick baby while you go outside for a smoke." SO TRUE!
Hey, someone stole my initial! :P Great post and lovely finale.
There should be a Patient's Guide to ED. Waddaya say, up to it? I don't get why people bother coming and waiting for hours for a cold when they could go to the chemist or to bed...?! Seriously, I'm puzzled.
amanzimtoti : thank you for your kind comment.
t. : it was true. I did get to cuddle a very cute baby as well. Shame about the mothers priorities...
t : Patients Guide to the ED? Sounds like an idea....I have exams to procrastinate before. If anyone has any suggestions for this, flick me an email at thedragonflyinitiative at gmail dot com
HAHAHA. v true and v touching :)
glad you're enjoying ED! :D
Awesome post! :)
New reader, here via Vitum medicinus, and enjoying what I'm reading.
As the parent with a daughter having Down syndrome and Eisenmenger* syndrome, we tried our best to handle her medical needs without resorting to the ED, and I think we did pretty well. It helped lots that our PCP has Sick Call in the afternoon for patients who need to be seen the same day. It also helped that her doctors would rather see her when I was uncertain, and tell me the issue was minor, than have me stifle my suspicion and she be sick enough outside normal office hours that I could not wait until the next day.
Part of my reluctance to visit the ED with her has been the fear that she will catch some respiratory bug or virus in the waiting room AT THE ED. Her lungs already compromised, that's an Avoid whenever possible.
Part is having to explain her uncommon condition and medications to someone who's never seen her before, and isn't likely to see her again after this night. Not that I mind explaining, but it's rather a lot to take in, in one go.
Oh, the medications - I wrote out all her meds on an index card, with dose and frequency, the date the card was last updated and her name, then sealed the card in layers of packing tape. She carried it with her in her wallet so she would have the lot handy whenever needed.
*Eisenmenger syndrome - I wrote a definition for her website as if she were telling it, and have gotten compliments on the clarity. http://margretfan.homestead.com/EisenmengerDefinition.html
Ann: Thanks! The ED is there if you need it, but certainly fair enough to avoid it unless completely necessary. In all but one (overseas and not first world) hospitals I have been in, great lengths are gone to to protect people such as your daughter from all the germs that could be floating round EDs. Oncology patients, the immune suppressed, patients with CF or other causes of bronchiectastis, and others are often taken straight to the ward or out of the general area. Sometimes such patients have cards to show at triage (some joke that it is the Qantas club card to get them priority for boarding) and in others they never present to emergency and go straight to the ward where their doctor will see them. Being able to see a Primary Care provider is fantastic as well.
And carrying all the information is wonderful, the better the communication, the faster that good care can be given.
Your and Margaret's definition of Eisenmengers is fantastic. I may use it in future myself if you don't mind.
Dragonfly, you are welcome to use our definition of Eisenmengers if you find it useful. Perhaps I should put a release at the bottom of the page, asking only that credit be given to Margret and her Mom.
Margret was all about explaining pulmonary hypertension and Eisenmengers to any new doctors she met(or drafting me to do the explanation). PH can be hard to diagnose, and after reading about Brooke Di Bernardo, who died at age 14 after 8 doctors missed the diagnosis, Marg wanted any doctor she met to have PH in the back of their mind if they saw someone similar.
I certainly appreciate having the ED available. My definition of 'completely necessary' is very different from that of some of the folks I've seen in the ED waiting room.
I knew, before Margret had her diagnosis of PH and Eisenmengers, that she caught stuff easier than her sisters, and was remembering specifically one visit where we sat in the waiting room for 6 hours. She had mentioned a pain in her leg when she was going to bed, but insisted in the morning that it didn't bother her. Her aide for the day told me this pain had recurred and bothered her noticeably. On questioning her, she said, yes, now it hurts a lot. I called the Primary and got her seen, then he sent us to the ED for an ultrasound, suspecting a DVT. By the time it was our turn for the interview, the ultrasonographer had gone home for the day. They called his home to ask him to come back and see her. He turned around and came back. Because of the hour, and the worry, he let us know she didn't have a DVT instead of sending us home to wait for the doctor to call on the morrow. There may have been a better way to handle the situation, but I couldn't think of any at the time.
She came down with a coughing, sniffling, sneezing thing early the next week.
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