60 Hours

When I started my emergency medicine residency, I was told that all of our shifts are 12 hours long. Coming from a surgery residency where shifts can be 30 hours long, I was looking forward to the break. Having just spent the last five nights working a series of 12 hours shifts, I have realized that the hours add up pretty quickly.

While I can't write about everything that happened over the last 60 hours, I can hit the highlights. I have also found that the more tired I am, the more surly I become with patients. After a brief 18 hours to adjust from night shift to day shift, I was back at work this morning. My body was telling me that it was nighttime and I should be sleeping. Caffeine does wonders for the sleepy mind.

Anyway, what do I remember most about my last block of shifts:

- even pretty teenage girls from good families can be more troubled than you would think. I sewed up a 5 inch cut across her arm where she was "cutting" to hurt herself. It matched a series of other cuts that she had already put on her arm. This one was deeper than those, and I had to sew the wound closed in several layers and oversew a blood vessel that she had cut as well. Off to psych services, and probably alcohol rehab. She'd already lived more in 15 years than I had at 3o.

- the legend that people are more depressed around the holidays never showed more true than in this weekend after Thanksgiving. Our board shows the 20 rooms in the E.D. At least once per shift this weekend, there were 8 - 10 OD's, SIWL (self inflicted or suicidal ideation with laceration), rehab, depression, alcohol withdrawal, AMS (altered mental status), etc. on the board. It got so bad that I said that if I had to see one more suicidal patient or OD I was going to commit suicide. My senior actually called over to psych services to see if I could be committed for making a suicidal intent statement. They said yes, and that they would be more than happy to send security over to restrain me for a while. All in jest, but really... I was going crazy.

- there was a sale on car wrecks. Crash yours into someone else's and you both get seen for free!

- we had the first snowmobile accident of the year. No snow on the ground, he'd just had it tuned and wanted to hear it run... and it did, right into the building then flipped over on him. He had no injuries, luckily. We'll see how the rest of the season goes.

- for some reason, more stabbings are happening than shootings. They're a little hairier because you don't know just how far down the blade went. Bullets you worry about the path. Knives you're dealing with too many variables. We CT scan everyone. Oh, and marijuana is considered by some to be medicinal for post-traumatic stress following having been stabbed by your best friend who was high on "some pills" and thought you were suddenly out to get him. It's not.

- some attendings I get, some I just don't. Wonder what kind of attending I will be?

- even big strong 36 year olds die. Suddenly. We had one with a massive pulmonary embolism that died around 3 in the morning several nights ago. We worked hard to bring him back. Nothing would work. It affects the whole staff when something like that happens. Of course, I also had the 38 year old with end stage AIDS whose mother signed the "comfort measures" paperwork and then wouldn't let go of them. We all knew it was in the patient's best interest. I can't even begin to imagine the feeling of signing a paper that will limit the care your child receives. No matter the age, they are always your baby.

- which makes me salute all the mothers who brought their child to the ED for help and sat by their side while I explained what happens when you OD on soma, lortabs, alcohol, antidepressants; or while I sewed self-inflicted lac after lac; or who encouraged them to get help from Abuse Intervention Services because they "couldn't take it any more."

OK, it's late and I have one more shift before getting some time off... be happy! My ED patients have been so depressing lately.