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11 November 2008

Heal With Nerves of Steel

Suburban has been a really great experience. I am seriously enjoying my work there as I see a great variety of patients and diseases. However, a twelve hour long shift can be taxing, and on Sunday I was getting ready for my shift to be over... Since the board had been full all day, I was planning on seeing one more patient before ending my day, when the family practice resident I was working with asked if I wanted to swap patients.

She had just picked up an abscess case, and I was going to go see a woman coming in from another hospital with an "unusual finding on CT." I agreed as the abscess case could probably be finished before the end of my shift, and I wouldn't have to sign anything out. I am glad I did. I know comments have been made about doctors being the worst patients. However, I've found that working at Suburban, we seem to get a lot of families coming in with family members who are physicians, or nurses, or paramed
ics, etc. They can cause us a lot of grief sometimes... but, more on that later.

My patient was a college student with an abscess on his tush. He'd already been to an urgent care center and had been prescribed antibiotics, but the abscess had just grown bigger. So it had be opened. Oh yeah. I have a friend from med student who once said that there was nothing more satisfying than draining an abscess, and I have to agree. Plus it meant I got to cut into someone and given the way the day had been going, I was more than eager to wield some steel.

After numbing the area, you basically make two incisions, "place the mark of Jesus on him" as my attending told me, and let everything drain out. I prepped the area, gave the patient adequate anesthesia and enjoyed the gushing, um, fruits of my labor. After exploring the abscess cavity to make sure there weren't any further pockets, I stuffed it full of packing. I then instructed the patient on wound care and told him to come back on Tuesday. I'll be working, so I hope I get to follow up on him.

When I came out of the room, it was like a war zone had set itself up in the E.D. First off, there was a patient found down that the EMT's decided to put onto the rig. Then when he was pronounced, they were obliged to bring the patient into the E.D. as they couldn't then remove the patient from the back of the ambulance. The family followed the patient to the hospital and soon there was the sound of crying and wailing throughout the E.D. At the same time, a family brought in a patient after chemotherapy. They were saying that the patient sometimes got a little "loopy" but this time they were much worse. So much so they were having a full out delirium and screaming and crying in their room. Then, the doctor family member of the patient I had traded the family resident with began demanding and belittling the staff to the extent that security had to be called.

The family medicine resident told me that when she explained to the family member that the attending was dealing with a patient coding (meaning CPR resuscitation) he stated, "That patient is probably dead and my wife is in pain. He should be here seeing her." Which went along with the family member of the delirious patient who kept following the RN's around asking that something be done about his family member. When my attending tried to explain that he had a patient that was sicker, and the family member didn't want to hear it, the quote was, "I have a patient who isn't breathing and this one still is, so I have to attend to them first."

I know it's hard to understand the system of triage when it's your loved one in trouble, and I can sympathize and apologize to patients when I go in to see them, but I can imagine with the change in leadership, things are just going to get worst. But, I will reserve getting on my soapbox for another time. It's late, and there's another shift in about 10 hours, so I better get to sleep. Will follow up on everyone. If there's a case in particular I've mentioned you'd want to hear about, let me know in the comments... We have to follow up on our cases, so I usually know what's happened to someone once they've left the E.D.

Until later... cheers!

p.s. other interesting cases during the shift: Bell's palsy in a 30 year old, an 80 year old runner who still walked 4 miles a day coming in with fulminant heart failure and not really having any symptoms, the 75 year old who went into sustained V-tach and needed to be shocked out of it, both of those patients had to be on amiodarone drips to keep their heart rates regular, and the 30 year old pregnant woman I got to reassure about her baby.


ADB said...


I guess that in the Emergency Room you get to see everything. In situations like you describe, people tend to be just a little bit selfish.

Julie said...

I had 2 patients coding at once one time and one of my other patients husband followed me into a code room yelling at me because I wouldn't stop and get his wife a suppository. You have got to be kidding me! I told him he had 2 seconds to leave the room or I would have him escorted out by security. Of course I got in trouble for it, sigh, but it was satisfying. Sometimes the family is worse then the patient could ever be.

Claudia's thoughts said...

My husband (RN) works in a Level trauma center in Pittsburgh, and the clientel thinks that it is a first come, first serve basis. "You didn't take me because I am ______(add you description); even thought they were there for a STD check. The whole world thinks the world revolves around them. He would like to ask "Just what time was your appointment????" But you can't do that. Most of them are too lazy to make an appointment and go to their assigned PCP; it takes too much effort!!!!!!


erarein63 said...

They never get it do they? I don't know how many times I've used that line as well (pt in rm1 isn't breathing/heart not beating and I'm sure would like to trade places with you, so why don't you have a seat back in your room and I'll get back to you as soon as that pt is either dead or not dying". **Sigh** And to Claudia...I've said "this is an ER, if you expect an appt see your doctor." But I still wouldn't trade it for the world because despite my thoughts otherwise, I do make a difference!

MariesImages said...

My father went in yesterday for hip replacement. He is in his mid-seventies, so we were all nervous for him. The hospital staff were wonderful! All were very kind & understanding. It made the experience a lot easier. They even let us all sit in with him, about 7 of us, before the operation.