What exactly are ERs for?

I really enjoyed my ER rotation. I was at a busy level 1 trauma center and got to work a variety of shifts. I felt useful, which is not always the case as a student. However, I couldn't help but realize the number of people who came in for things that would have been better taken care of by their PCP. I know some patients don't have a PCP but many do. This influx of the unnecessary lead to overworked doctors and long wait times. I don't know the solution but maybe patient education would be a good start. I would hear doctors talking among themselves that patients should have gone to their PCP but not many passed this to the patient directly.

Some of my favorite "emergencies"
1. I have a cough. It is non productive and I think my cousin had something similar last week.
2. I am vomiting. But upon further questioning the patient had vomited once, and kept down some juice in the ER.
3. My son had a rash two days ago. It's gone now but I brought him here to make sure it is gone.
4. My tooth hurts. I think I have a cavity but I hate the dentist.
And my favorite 5. Dandruff! Yes, I saw a child for dandruff in the ER. To be fair her grandpa was worried about ring worm, still not an emergency in most cases.

When patients say what you can't

Approximately 2am. A child with a history of sickle cell was admitted for observation around 5pm due to fever and cough.

Nurse Practitioner enters room. Begins to examine child but notices a bed bug in a cup by the crib.

NP: "Um. We are going to have to relocate you all to a new room."

Parent: "WHY??"

NP: "Well..." looks at cup, then at parent "This room is going to have to be fumigated."

Parent: "Oh my GOD!! There are bed bugs here!! We are leaving! I am going to tell everyone what a nasty hospital this is!"

NP: "I really suggest you don't leave. Your child needs to be observed for at least 48 hours. We will get you a new room."

Parent: "No!! I will leave and you will pay for my transportation."

NP: "I can't do that. Especially if you are taking your child from the hospital AMA."

Parent: "You can't tell me what to do! I will call the news about this!! Nasty hospital!"

By this time the room mate is awake and her mother is quietly getting their things together. She has had enough of the loud parent.

Room mate's Parent: "Shut up! I have been in this hospital for 3 days and aint seen no damn bed bugs. You probably brought them here yourself!"

Loud Parent and NP take their conversation to the hallway. Unfortunately they did leave AMA but the child followed up in clinic a couple days later and was fine.

Pregnant ladies are funny

I really enjoyed OB. There is just something special about sharing in such an intimate time in someone's life. Funny things happen in the later parts of labor though..

"I'm not mad at you! It is just if I look at you while I am pushing I get ANGRY!"

Patient: Please pray for me.
Patient's husband: Prays and holds her hand. During a difficult contraction prays a little louder.
Patient: PRAY QUIETER!
Patient's husband: Sits on room couch and prays silently.

Even the doctors get crazy:

Patient: I can't do it!
Nurse: You have to.
Patient: Just use the vacuum and pull it out!
Nurse: It doesn't work like that. You can do it.
Patient: Get Dr. Smith! She will pull it out!!!
Dr Smith is paged for hysterical patient and arrives in about 5 minutes.
Dr Smith: What is going on here?
Patient: I can't do it! Pull it out!!
Dr. Smith: Now listen. I want no more screaming until there is a baby in this room. You can do this, and you will.
Patient: Quietly delivers baby girl in five more contractions.

Feeling Frisky

Me: Good morning.

Patient: Morning. Good to see you again!

Me: How are you feeling today?

Patient: Frisky. Hop up on the bed with me!

Me: I don't think that is allowed sir.

Patient: Oh, well can't blame me for trying.

I'm back!

If anyone is still reading I am so sorry for the delayed absence. Third year has been quite difficult these past few months (surgery was one of my recent rotations so anyone in medicine can understand that one!)

I have been tucking away stories in my memory and will start sharing them again with you. I am also hoping to post some longer pieces as I have noticed I really miss writing (I considered a career in journalism for a time so writing continues to be an outlet for me).

First "real" return blog post tomorrow so stay tuned!!

Be back soon

Sorry for the lack of posts. I am on a difficult rotation right now! Very thankful for the Thanksgiving holiday coming up. I will be spending it with family and hope you all get to do the same.

Will try to post more starting Monday.

Happy Thanksgiving to you and yours!!!

Mr. Sleepy

I know it is a necessary part of medicine but I do feel bad for patients that pre-rounds and rounds tend to be early in the morning. This particular patient was being treated for hepatic encephalopathy and not getting quality sleep due to seizures. Come 8am rounds we have to wake him up, and part of the exam is to document how oriented he was given his diagnosis.

Attending: Mr. Sleepy, how are you?

Mr. Sleepy: (snore)

Attending: Mr. Sleepy. Wake up. (gently shakes patient)

Mr. Sleepy: Huh, yes. Hi.

Attending: How are you?

Mr. Sleepy: Tired.

Attending: Yes, do you know where you are?

Mr. Sleepy: The hospital.

Attending: Good, and the month?

Mr. Sleepy: Huh, oh, September.

Attending: Well, today is October 1st so I guess that was a trick question.

Mr. Sleepy: (snore)

Attending: (gently shaking him) Mr. Sleepy, who is the president of the United States?

Mr. Sleepy: ..... (sigh, grunt).... Osama ..... (snore)

(The various residents and students is the room start laughing. Luckily Mr. Sleepy is undisturbed by this and continues to snore lightly.)

Attending: Ok, Mr. Sleepy, just don't say that to anyone else.

Mr. Sleepy: (snore)

(The Attending does a quick exam and we move on to disturb the rest of the next patient.)