These Shoes are Made for Walkin'

Sometimes you just have to buy something because it's so fun! Like these shoes. I now have 4 pairs of Dansko clogs which seem to be the shoes de rigeur amoungst the medical set. Wednesday was payday, so I went to my local outfitters to get a pair of black clogs for work.

I wanted a pair of black ones since I occasionally wear my clogs for quick trips to the market, or for meetings at the hospital, etc. When I went into the store, I saw these, and even though I am pretty conservative by nature I knew I had to get them. They are the same reliable comfortableness of all Dansko shoes, but just a little funkier.

You usually don't think much about your shoes until you are in them all day. And the last 2 shifts have been so hellish that I am glad to be wearing something solid and comfortable to carry me through those long 12 hour days. My colleague that was shopping with me asked what I would do if I spilled something on them, or had something (think biological material) drip onto them. I guess jump back and avoid the spill. I don't care, they're funky and cool as well as practical.

I think the nursing home floodgates opened up the last 2 days, and the ED seemed to be running a promotion on hospital admissions as my admit percentage ratio was around 75%. Last night I was 50/50 between admissions and discharges. There's just too many falls with hip fractures and chest pains to be evaluated. And, it's not even the beginning of pneumonia season yet.

Coming here this morning, I was thinking about how people don't realize that every single step of being seen in the E.D. takes time. You're triaged when you walk in the door. Triage - people who are sicker get to go first. And, you can't fake it. Vital signs don't lie. You can't say you have a high fever and then have a normal temp here. You can't say you can't breathe and then have a normal oxygen saturation on the pulse ox. Roll around on the floor saying you're having severe abdominal pain, and the triage RN will feel your soft stomach and know you're good for another couple of hours.

Then, you get into a room. First the aide takes your vitals. Then the RN does their exam. Then the M.D. gets the chart. After being interrupted by phone calls, bed hold orders, another nitro for the CP in 7, the M.D. will attempt to make it to your room. On the way, the psych patient in 13 will decide the walls are covered in bugs necessitating a B-52 (benadryl 50, haldol 5, ativan 2). When they finally return their second page out to the admitting attending for the patient in 22, the M.D. will make it to your room.

In my case, I then have to present to the attending that is managing all the other 20 patients in the E.D. along with 2 P.A.'s, a med student and another resident. So, I have to wait my turn. Finally, we decide on a plan, order labs, films, etc. I then place the order with the clerk who may or may not have called her kids for the 5th time to tell them that "no, you can't spend the night at Sally's because your father is going to be late and you need to watch the other two." When they finally get around to placing the order, if you have a film, you're again triaged behind the chest pains, the shortness of breaths, the other 10 abdominal pains, and the little old lady who fell over her walker while getting ice cream and now can't stand.

Two hours later when we have a second to look at the results of your labs, if they're all there and I don't have to be calling to lab to see what happened to them, or asking the RN or asking the aide who was supposed to have delivered them, but instead stopped to gossip in the stairwell with the cute guy from the third floor, I will finally see if I can figure out what's causing your _______.

Then I have to again talk to the attending, wait for your doctor to call me back, the consultant to call me back, the admissions' clerk to take the order and find you a bed, and the RN to finally send off the urine sample you haven't provided because you can't seem to hold the cup in the right spot, I might just come into the room to tell you I didn't find the reason for your abdominal pain, and I am going to discharge you to follow up with your primary care physician... which, might I say, you should have done in the first place since you've been having abdominal pain for the last 5 weeks, and tonight thought you should get it checked out because you saw a special on Oprah that talked about colon cancer.

I really should get a pedometer... I'm going to be getting a lot of mileage out of my new pair of shoes. Wait, first patient of the day... I know it won't be the last!