Not Newsworthy

I have been working at the ME's office for the last three weeks. Wow. While I can't talk about the specifics of what I see every day down in the autopsy suites, at least I can post the local news stories about the cases that are coming down to the morgue.

I attempt to find stories that don't list the names, but some stories are so widespread that names have already gotten out. Most of those are the locally high profile killings and deaths. While I might list that we did a suicide on a particular day, although I know the person's name, I don't list the obituary because I think that would be disrespectful to the person, and especially to the surviving family.

Some deaths, though, no one reads about. The prisoners who die while serving their sentences. The single overdoses that are found by friends or family members. I add the suicides in here, because they sometimes don't even get an obituary. Children are in here because SIDs, suicides and sudden deaths, for the most part, don't get reported. And the tiny victims of drug-influenced mothers who never live to take their first breaths, mostly because they are too premature or died before they were born, they generate no print as well.

We had a full room today. Three tables all going at once. No news stories on any of them. They were simply: The Overdose, The Accidental Overdose, and The Found in Woods.

Stories that did make the news from earlier this week:

Hot Dog Death
Shooting on Porch

Until next week!

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.

And Now, Back to the Drama

I think I have mentioned on several occasions that one of the things I like most about working in the E.D. is the patient's back story. Their presenting complaint for the most part is routine, but the way they came to be in the E.D. usually is interesting. That's why I like ECMC. Patients there are not boring by any respect. Every day is like a soap opera; there's a plethora of drama for everyone to enjoy. And, it's played out right in front of you.

So lets get started on today's episode of "As the E.D. Turns." Questions I asked the patient are in red.

Dx: Sickle Cell Crisis - "I think I am dehydrated because I have been drinking anything I can get my hands on because I am upset about my fiancee who got really sick from her diabetes and is now in a coma, and I drink from the time I get home from seeing her until I can't drink any more. And, I am changing doctors and my current doctor only gave me enough pills for a few days because they didn't know me, and now I am out of my oxycontin's and dilaudids, and now I am having a lot of pain, and I think I need a shot of something."

Dx: Constipation - "I've been having abdominal pain for the last two months, and I've been to three different hospitals. My doctor won't even see me because she's only available on Mondays, and I was having abdominal pain, but I didn't have severe pain until today, and I knew that I couldn't wait until Monday, but then she wouldn't see me anyway because I always have to go see the nurse practitioner, and I never get to see the doctor." Why didn't you go back to the last hospital that saw you and has all your tests and records? "Well, I didn't like them there. They told me that nothing was wrong, and that I was just constipated and then they admitted me and then I felt better but then my doctor didn't work there so then I wouldn't have my own doctor, and this pain is so bad and I didn't want to wake up my brother because he sleeps in the room above me but he was so worried about me and what are you going to do to fix me?"

Dx: 4th metatarsal fracture - "Well I was fighting this girl and then she suddenly came out and stepped on my foot, and I haven't been able to walk on it ever since." Well, how have you been getting around? "I've had to crawl on the floor."

Dx: Overdose and suicidal ideations - "Well, one of my kids had a scratch so someone called CPS, and then they said because of the bruises that I would have to go to court, and then my husband said that (mumbles something incoherently) so then I decided that I couldn't live in a world without my children and I took all the pills."

Dx: Multiple stab wounds - "I was fighting with this girl and then all of a sudden I felt this pain, and then I realized that I was bleeding and I couldn't believe that she would do that."

Oh... and the Award for highest blood sugar I've ever seen in a fully conscious patient goes to my homeless man who presented with a blood sugar of 1048. Yeah, that's right! Four digit blood sugar.(btw normal is around 100, most doctors recommend diabetics keep theirs below 160).

And, in my "Art Imitates Life" section: Tonight's episode of Grey's Anatomy had a storyline where one of the doctors Callie suffers a broken nose after getting clocked by the elbow of a patient... during a code today, I was placing a central line in the patient's femoral artery (in the thigh) when I bent over to get something from the kit I had to place on a chair. I was just about to turn back to the patient when one of the nurses toward the head of the bed turned suddenly and clocked me with her elbow. Not enough to daze me, but I did have to suffer through CT and subdural jokes for a part of the shift.

You have to watch out... life moves pretty fast in the E.D. Oh. yeah!