Second Shift: Stories from the ER and Med School

If It Quacks Like a Quack...

2011-04-22T07:36:00.002-04:00

The New York Times profiles Andrew Wakefield, the discredited British physician whose paper attempting to link the MMR vaccine to autism was retracted last year, and whose medical license has been revoked. Meanwhile, the number of needless childhood deaths from completely preventable diseases like measles continues to increase among the unvaccinated.

Big Time

2011-04-20T09:35:00.004-04:00

Just discovered that Second Shift has made it to Ambulance Driver's Blogroll O'Doom. AD is one of my favorite reads, and I've taken to occasionally listening to his podcasts on my long runs. To any new readers that happen this way, thanks for stopping by!

Give Blood

2011-04-18T07:00:00.001-04:00

Middle-aged male, history of chronic EtOH abuse, arrived via EMS for an uncontrolled upper GI bleed. Quickly intubated to protect his airway, he was hypotensive to the 50s. Piles of used blood bags formed at the base of the rapid infuser as the medical team attempted a transfusion to stabilize his pressure. With blood oozing out of his nose and mouth as fast as it could be given, he remained hypotensive, with periodic bouts of arrhythmia, for an extended period. Finally stabilized long enough to be brought upstairs, we learned less than an hour later that he coded and died.

Without donated blood products, this patient would never have even made it out of the ER. Donated blood isn't a cure-all, but it does help save lives every day.

Only 8% of eligible Americas donate blood. If you're able, please be a hero and consider donating blood.

I Whip My Brain Back and Forth

2011-04-15T00:01:00.000-04:00

Dear High School Student,

Welcome to the anatomy lab demonstration. Your extreme enthusiasm for real cadaver parts will make you a great sociopath and/or physician healer.

I regret to inform you, however, that you are not Roger Daltrey, and that spinal cord does not lead to a microphone. Kindly refrain from swinging it as such.

Thank you for your consideration.

Sincerely,

Second Shift

Lessons Learned

2011-04-12T00:01:00.001-04:00

Well, med school sure did get busy there for a while. I wish I could claim that I spent the last month and a half elucidating the intricacies of Chédiak-Higashi Syndrome or memorizing the effects of each and every cytokine, but the truth is that even if I had, those nuggets of knowledge would already be forgotten.

As always, the most memorable lessons come straight out of the ER.

Like, when you flee the bank with the bundles of cash you just stole, resist the temptation to stuff the bills down the front of your pants.

When those explosive dye packs go off, they're going to damage some pretty valuable real estate.

It's Not a Toomah. At all.

2011-02-22T00:01:00.002-05:00

After endless hours studying human pathology, it's not uncommon for medical students to become convinced they suffer from a rare disease or two... or eight. During a psych block, for example, the incidence of obsessive compulsive disorder self-diagnosis among my first year class shot up astronomically.

With much of this week's schedule devoted to discussing brain tumors, I feel a bit of prophylactic cautionary advice is in order. See, in learning how to make a diagnosis, we're taught to remember Occam's razor - that, in general, the simplest explanation is most likely. In other words, that dropped pen or sudden muscle jerk in lecture probably results from dozing during class and not a cerebellar lesion.

Moral of the story: you probably don't have a brain tumor. And if Occam isn't a funny enough last name for you, take it from this guy...

The Bionic Man

2011-02-17T00:01:00.001-05:00

Spend any amount of time in an anatomy lab and you'll quickly discover that the crisp, bright colors of a Netter's atlas are nowhere to be found in an actual cadaver.

Which means if you happen upon oddly vivd pink gums while bisecting the head, they're probably dentures. Shiny silver prongs poking within a great vessel? That would be an IVC filter. And no, that bright yellow tube left in the urethra is not another fascial plane, but a foley catheter left for you to find.

All these surprises laid in wait deep within our cadaver. Other highlight from our class included a pacemaker and an artificial hip.

Still, I doubt anything will ever top the handicap parking permit I once encountered buried in a patient's skin folds...

Playing Doctor

2011-02-16T16:36:00.003-05:00

I'm just going to take a quick listen to your Beatles collection, sir...

Stethoscope headphones via Geekologie.

Valentine's Day

2011-02-14T20:01:00.002-05:00

Ah medical school, where the most physical contact I'll experience on Valentine's Day involves practicing the cranial nerve exam...

Whatchu talkin' about [Circle of] Willis?!

2011-01-31T00:01:00.000-05:00

"Note: do NOT decapitate the cadaver" - Anatomy dissector guide.

Easier said than done, actually, when you consider that the last several weeks have involved sawing through the skull to peel out the brain, disarticulating the skull from the spinal cord to expose the back of the larynx, removing the skin to visualize the muscles of facial expression, sawing again to bisect the face, and removing an eye from its socket.

This of course is in addition to previously removing all the organs, sawing the thorax apart from the lower body, bisecting the pelvis, and more recently, slicing the brain into tiny pieces.

Barbaric? A bit. Tiring, frustrating, tedious and serial killer-esque? At times. But our now completed gross anatomy course was also a pretty phenomenal experience - humbling, challenging, rewarding and (literally) eye-opening.

I can't say that I'll miss the smell of formaldehyde, but I remain incredibly grateful to the women and men who donated their bodies to further our education.

To them and their families: Thank You.

Homeopathic ER

2011-01-28T00:01:00.000-05:00

In case I don't pass this mega neuro block that has dominated the past month, I suppose I could always try working here...

Friday's Food For Thought

2011-01-21T00:01:00.005-05:00

Typically sage wound care advice from The Onion's health desk: pick at it.

"If it doesn't smell like cheese, don't worry: You just need to pick at it some more. "

"Remember, the two best doctors in the world are right there at the end of your hand: your thumb and your index finger. So get in there and pick it!"

I'll try recommending that next time I'm in the ER.

A Friendly Reminder from the ER

2011-01-12T07:48:00.004-05:00

As much of the country begins cleaning up from the snowstorm, just remember: hands and snowblowers don't mix.

Update: Shoveling can be pretty dangerous, too, says the American Journal of Emergency Medicine.

Open Wide

2011-01-12T00:01:00.001-05:00

Popular imagination aside, in my years spent working in the emergency department, foreign body removals just really weren't that common. Of course there were occasional instances where objects found themselves in unlikely places -- "Sir, either we wait for the laxative to help the golf ball out, or I'm afraid you'll need surgery" -- but they really weren't a frequent occurrence.

I can also dispel any rumors of a "hall of fame" of removed objects... you'll find no drawer of lightbulbs or Coke bottles in the Big City ED. You will, however, find a very impressive collection of foreign bodies detailed in a new book about a pioneering endoscopist. Profiled in the NYT, Swallow tells the story of a turn of the century physician who removed (and kept) everything from keys to miniature binoculars from inside his patients.

Makes the pen I once saw fished out of a patient's throat seem not nearly as impressive.

Art Imitates Life

2011-01-11T00:01:00.000-05:00

Stolen via facebook from a friend of mine, a cartoon guide to becoming a doctor. Very funny, and from what I've experienced so far, scarily accurate.

Just One More Question

2011-01-10T00:01:00.002-05:00

In addition to our love of distinctive coats, Lt. Columbo and I share something else in common: we're always asking one more question. As a first year medical student, I practice taking a history and physical on patients in the emergency department. It's a great learning experience and a needed counterbalance to the hours spent in the library, but it requires some patience from the patients.

A typical ED patient will be likely be asked a similar set of questions by a triage nurse, their actual nurse, a resident, maybe a 3rd or 4th year medical student, and the attending. At the end of a long and uncomfortable visit, plucky Second Shift, MS-I might not be exactly what the doctor ordered.

Which is why my mentor and I always ask the patient's permission before I take their time, explaining that this opportunity is a valuable part of my education. If the patient looks too sick, or would rather not be bothered, we thank them for their time and move on. A few are annoyed at the interruption, some respond only with terse replies, but the overwhelming majority generously give of their time and eagerly participate.

While reconnecting with family over the holidays, one older cousin asked if I had begun interviewing patients yet. He angrily recounted how a medical student once asked him about symptoms that he never had, accusing the student of being lazy and not taking the time to actually read his chart. I tried to explain things from the med student perspective, but whether the student was actually lazy or just conducting a review of symptoms, we'll never know.

So, to anyone who has ever endured a barrage of seemingly random questions from a neophyte medical student: Thank You. It may be a bit of a hassle, but you really are helping us become better doctors.

Friday's Food For Thought

2011-01-07T00:01:00.001-05:00

Identifying structures in the murky, monochromatic mess of an MRI of the brain is just one of the many challenges of our recently begun neuro block. (Memorizing hundreds of new anatomical terms would be another.)

While a career in neurology is almost certainly not in the cards, I have looked at enough scans to recognize that the above image is not -- despite its slight resemblance -- a human brain.

It is, however, an MRI of a bell pepper.

Thanks to a friend who trolls the internet to find awesome sites like these, I have been procrastinating lately by spending time on the "Inside Insides" blog, which features MRI scans of food (check out CT scans of a chicken McNugget here).

And now, back memorizing those cranial nerves...

Hmm, You Should Ask a Doctor

2011-01-03T00:01:00.001-05:00

Typically when I gather with my family around the holidays, everyone enjoys retelling the same embarrassing stories of yesteryear. That time when I vomited out of a moving vehicle. The trip where I ripped my baby brother's stuffed animal out of his hands because I was scarred of the baggage claim at the airport. And who can forget the day when wee little Second Shift got so excited at Discovery Zone, he found himself in need of a dry pair of scrub pants? Ah yes, the memories.

This year, however, was the damnedest thing. Rather than the 20th recounting of how I very nearly burned the house down with a birthday candle, family members were instead seeking my expert medical advice. Now, they warned us that this would happen when we received our white coats, but I thought if anyone could see through that charade, it would be the same folks who remember me from my too-fat-to-wear-a-turtleneck-because-it-would-strangle-me days. I was wrong.

"I've had a pain in my back, but today it moved to the front, why is that?" "Can I take medicine X with medicine Y?" "You're the doctor, why do I sometimes wake up with a stuffy nose and sometimes not?" "Hey cuz, can you write prescriptions yet?"

Folks, if it doesn't involve one of the enzymes of glycolysis that I've long since forgotten, you're out of luck. Predictably, the only one not to get caught up in the collective madness was Uncle Jerk. As my father pushed him to seek my advice on his treatment options, Uncle Jerk replied that unless I had taken out a few hundred prostates in my first few months of med school, he'd stick with the real doctors.

Glad we're on the same page for once, Uncle Jerk.

My Precious

2010-12-27T00:01:00.001-05:00

Back when I worked in the Big City ED, we had a nurse named Bob. Now I'm sure Bob was a perfectly wonderful human being, but he was not a great ER nurse. Bob didn't like commotion. He didn't like multi-tasking. He was no fan of confrontation. More than anything else though, Bob hated, and I mean truly and completely despised, when someone moved his charts.

Finding a chart lying on the counter rather than stacked neatly in the rack put Bob over the edge, so much so that he once famously kidnapped all the charts, relocating them to the med room and hiding them among the lidocaine vials behind the safety of a locked door. Any attempts to access the abducted charts by another member of the team was rebuked. There, safe from greedy grubby hands grabbing his precious charts, Bob remained holed up to jealously document on his well-organized beauties. (His tenure in the ED was short.)

Sitting around the Christmas tree this weekend, I was reminded of this humorous episode by noticing the same possessive leer in the eyes of one of my younger cousins. Still a few years shy of truly appreciating the whole "giving is better than receiving" tenet of the season, the little rascal wolfishly gathered his presents from under the tree and arranged them in a neat pile at his feet. Positioned out of reach from the rest of the family, he was poised to start shredding the wrapping paper at the earliest acceptable moment.

Recognizing that look which screamed "Mine!" and smiling, I hoped at that moment my cousin would never choose a career as an ER nurse.

Around the Blogosphere

2010-12-22T07:20:00.003-05:00

I'm sure most of you read Movin' Meat already, but if not, take a minute to stop by and leave some kind words for Shadowfax. His wife was recently diagnosed with breast cancer. Between several years of working with kids with cancer, and losing a couple family members to the disease, I can honestly say cancer sucks.

On a happier note, Nurse K is back! Brace yourself for more hilarity and snark.

Med Student Heal Thyself

2010-12-21T00:01:00.002-05:00

For the record, I probably do not have an abdominal aortic anneursym.

I do, however, have a funny, recurring, pusatile sensation in my left lower quadrant.

Combine that with a a heightened sense of medical curiosity secondary to the elevated ignorance of a first year medical student, and you get several intriguing, bizarre, and universally fatal self-diagnoses.

It's kinda fun.

The Tables Have Turned

2010-12-20T00:01:00.001-05:00

For the first time in several years, I experienced a visit to the ER on the opposite side of the stethoscope. Now back home for winter break, I accompanied my father to the Local Hospital this weekend after an icy sidewalk led him to experience to a sudden and unexpected burst of gravity. After countless encounters with family members in the ER, I decided to employ several of their techniques to ensure we received high quality care:

*Upon arriving at triage, I spoke over my father to answer all the RN's questions. When she asked his pain, I replied "20/10!" while waving my arms emphatically. When his temperature was measured as 97.6˚, I informed the RN that it was "high for him."

*As our time in the waiting room approached an unbearable 10 minutes, I interrupted the RN while she was triaging another patient to ask if she was trying to let my father die. I also asked to speak to a manager.

*Once brought back, I explained to everyone that I worked in an ER, pointing to my Big City Hospital ID badge that I carry with me at all times. I also mentioned that I'm a first year medical student, so I basically know everything.

*While my father waited for X-ray results, I decided to wander the halls of the department, peering into other patient rooms and trying to decipher chief complaints while reading the board.

*Since my father hadn't eaten in at least 3 hours, I demanded two box lunches - one for him, one for me.

*When the doctor explained that X-ray showed no broken bones, I hastily began packing up our belongings and accused the stupid doctor of wasting our time and money on those pointless tests before storming out.

All in all, it was a very successful trip.

Extreme EM

2010-12-19T12:06:00.002-05:00

From the New York Times, another account of front line medicine in Afghanistan. Transporting a pregnant woman is stressful enough, but flying her in a Blackhawk helicopter over a war zone?

The Robot Will See You Now

2010-12-08T00:01:00.001-05:00

Blood pressure 220/110? Warning! Danger Will Robinson!

So it looks like years of education, hundreds of thousands of dollars in student loans, and a small forest's worth of lecture notes will all be for naught.

That's right, doctors are out, robots are in. At least in triage, that is. Vanderbilt University is working on the TriageBot, a machine that will take patients vitals, solicit their chief complaint, even wander the waiting room to make sure patients are still breathing.

Maybe I should start focusing on learning what R2D2's bowel sounds sound like?

Law and Order: Organ Preservation Unit

2010-12-01T08:19:00.003-05:00

We'd like to see your organs.

A patient having a heart attack calls 911, and an ambulance rushes to the scene to save a life. A second ambulance, with the words "Organ Preservation Unit" stenciled on the side, arrives a little later in case the first crew is unsuccessful. Like anything with organ transplantation, it's a concept with complicated ethical, logistical, and public relations considerations, but an interesting plan nonetheless. I still vote for a national opt-out policy instead.

I Don't Know

2010-11-22T00:01:00.002-05:00

As a medical student, I'm getting awfully used to uttering the phrase, "I don't know." I repeat it while studying, lament it when posed questions by professors and classmates, and hide behind it when asked for legitimate medical advice by friends and family.

At this point in my training, I'm just beginning to learn how to play doctor. Flubbing my way through the lines of the interview and pantomiming a crude physical exam when I see patients, I couldn't even pass as an understudy. Yet, by virtue of my white coat and stethoscope, sick individuals lying on stretchers occasionally confuse me for an actual physician.

It's still a little exciting, and always humbling, when that happens. A mini ego boost to be sure, but canceled out when patients actually expect me to know something. Like the woman who grabbed my hand, looked me in the eye, and fearfully asked, "Do you think my cancer will come back?"

My initial reaction was a flash of terror. I wanted to stammer that I'm doing my best to learn at least 75% of the material before each exam, and feel like I'm struggling to retain even a quarter of that information the week after. My charade had been exposed - I was soliciting details without any idea of what to do with the information, and possessed no ability to respond to questions asked of me in return.

So, I told the truth.

"I don't know," I confessed, still holding her hand, "but the doctors are going to do everything they can to make sure it doesn't."

How Times Have Changed

2010-11-21T08:00:00.000-05:00

College: Standing in line at Walgreens buying red plastic cups and ping pong balls at 10pm on a Saturday night.

Med school: Standing in that same line in sweatpants and flip flops buying a box of Cheerios.

Med School at the Movies

2010-11-18T07:52:00.008-05:00

Sometimes, it seems, you can only memorize so many muscles that sound like Harry Potter spells (Extensor digitorum!) before taking a break from the anatomy atlas and popping in a DVD.

Unfortunately, one side effect of medical school appears to be constant reminders of things we've studied. Using The Princess Bride as a study aid? Inconceivable, you might say. But consider the following examples of high-yield medical miscellany...

Polydactyly: The six-fingered man who killed Inigo Montoya's father. He likely suffered from an autosomal dominant condition.

Acromegaly: Fezzik's great size stems from an excess of growth hormone production by the pituitary gland.

Reversible injury: As Miracle Max points out, "Mostly dead is slightly alive." Perhaps Wesley's hepatocytes simply needed time to regenerate.

Hypertrophy: R.O.U.S. = Rodents of Unusual Size.

Feel free to use this helpful study guide as you wish.

For All You EMS Types...

2010-11-16T00:06:00.002-05:00

(To borrow a phrase from Ambulance Driver)

Esquire profiles a paramedic trainee's introduction into the unique world of emergency medicine. Hat tip to a friend for passing the article along.

Meanwhile, if anyone out there still reads this, I'm hoping to share some med school/ER stories soon.

Extreme EM

2010-11-09T00:01:00.000-05:00

Two of my favorite things... emergency medicine and running. Great article about brining emergency care to marathon runners in New York this past weekend.

Different Perspectives

2010-10-19T00:01:00.000-04:00

Back when I started as an ER tech, I was trained by ER nurses (kind of like being raised by wolves, but even more awesome). One nurse in particular, a seasoned veteran of several decades spent in various inner-city trauma centers, took me under her wing and first introduced me to the so-called intern's vein - a vein so easy, "even an intern can find it."

Flash forward a few years to med school, where a bunch of eager young med students attentively soak up a powerpoint presentation on how to draw blood. As the physician runs through the preferred sites for peripheral access, he finally comes to the intern's vein - a vein that "only the intern can find" (presumably after unsuccessful attempts by the nurses).

Same vein, just a slightly different emphasis that made me chuckle. Flash forward even further, and I can promise that if Second Shift the Intern is told by an ER nurse with 20 years of experience finding impossibly tiny veins on hard core heroin addicts that she can't find access, the first thing I'm going to do is grab the ultrasound.

To All My Old Friends in the Big City ER...

2010-10-14T00:01:00.000-04:00

and in emergency departments everywhere, happy emergency nurses' week!

Remember to be nice to the nurses - they keep the doctors from accidentally killing you.

This Week's Sign of the Apocalypse

2010-10-08T00:01:00.000-04:00

Man willingly risks death by delaying pacemaker operation in order to watch this weekend's Michigan - Michigan State game.

Back in Action

2010-10-04T00:01:00.001-04:00

After nearly two years of sharing stories about life in the emergency room, this blog took a detour when I began medical school. No longer working as an ER tech meant that my source of material had dried up. While I'm enjoying the journey so far, blogging about hours spent studying does not make for interesting reading.

So, it is with great excitement that I will soon begin a clinical mentorship elective in our medical center's emergency department that will allow me to interact with and begin to examine real ER patients. I'm really looking forward to being back in the ER, this time with a medical student's perspective.

Speaking of life in the world of emergency medicine, this weekend the New York Times ran a profile on the Maimonides Medical Center emergency department.

Be sure to check out the article, photo essay, and video.

Nerd Humo(u)r

2010-09-28T00:01:00.000-04:00

Science journalism, from our cousins across the pond.

After reading one or two scientific papers in my day, and then reading how they were presented in the press, this left me chuckling.

The Big Chill

2010-09-27T08:22:00.002-04:00

Cooling the body temperature of patients in cardiac arrest is becoming an increasingly popular method of reducing the damaged caused by a lack of oxygen. In the ER, I witnessed the adoption of a "code chill" protocol that involved an ICU team with a cooling unit for arresting patients.

According to this article, surgeons at Massachusetts General are preparing to employ a similar concept to trauma victims. By pumping cold saline through a patient's blood vessels, the team can lower body temperature to 10˚C, or a frigid 50˚F.

Claims the leader of the project, "By cooling rapidly in this fashion we can convert almost certain death into a 90 percent survival rate."

Pretty cool.

(Super) Bad Moon Rising

2010-09-22T17:32:00.007-04:00

Uh oh.

Anyone up (say, studying anatomy) later tonight should be treated to a neat celestial show. For the first time in 20 years, the autumnal equinox is occurring on the same night as a full moon, an event known as a Super Harvest Moon.

For stargazers of all stripes, I'm sure this will be a rare and exciting experience.

For emergency medical workers, I'm sure this will be a long and bizarre night indeed.

Truths About Anatomy Lab

2010-09-22T00:01:00.000-04:00

Scalpels are sharp. Speaking from experience, using a scalpel to dissect one's own flesh should be carefully avoided.

Also, my inner 10 year old wishes our cadaver was more like this:

Check out more images at Street Anatomy.

The Examinator

2010-09-21T00:01:00.000-04:00

One of the more exciting, and often intimidating, elements of first year is discovering how to interview and examine patients. Practicing first on actors, my classmates and I will shortly dive (closely supervised, of course) into real clinical encounters to hone these time-honored skills on the genuine article.

As I anticipate listening to my first heart murmur and palpating my first abdomen, however, debate swirls over whether the exam is properly taught, and how relevant it remains amid increasingly digitized medicine.

NPR ran a piece yesterday examining the current state of health of the physical exam, which some physicians maintain is a cornerstone of the doctor-patient relationship. For a different perspective, Shadowfax over at Movin' Meat argues that the full exam provides little benefit over a careful interview and well-chosen tests.

Will the exam stage a comeback, or will diagnostic testing continue to play an increasingly important role? I'm sure the debate will continue. In the meantime, I have a brand new reflex hammer to try out...

Med School (As Told By Cliches)

2010-09-20T00:01:00.001-04:00

It was the best of times, it was the worst of times.

Especially with all the information we are given; it's like drinking from a fire hose.

Sure my friends are making money and starting their careers, but the grass is always greener on the other side of the fence.

And remember, nothing worth doing is ever easy.

I mean, whatever doesn't kill you makes you stronger, right?

Someday, I'm sure, we'll all look back on this and laugh.

Occupational Hazard

2010-09-17T00:01:00.001-04:00

In light of the recent shooting at Johns Hopkins, CNN.com ran a front page story about violence in hospitals, especially the ER. Citing a study from 2009, the article highlights that more than half of ER nurses had been spit on, scratched, pushed, or verbally assaulted on job.

A nurse quoted in the piece describes how her jaw was broken in an altercation with a patient who later explained that he "was tired of waiting."

One of the draws of emergency medicine, for me at least, is the ability and mission to treat anything that comes through the doors. Given the patient population, nobody who chooses to work in the emergency department should be surprised when the occasional punch is thrown - we often see people at their very worst, and it's part of the job.

But when violence inches towards the rule rather than the exception, that's a problem. As another ER nurse observed:

"You would never go into the supermarket and say, 'the tomatoes aren't good enough' and punch the clerk and get away with it. That's exactly what happens in emergency departments all over the U.S."

"Just" A Nurse

2010-09-16T00:01:00.002-04:00

It never ceases to amaze me how often you'll hear someone refer to an RN as "just" a nurse. GuitarGirlRN's most recent post recounts a similar sentiment, namely that really "smart" nurses should have gone to medical school. When I hear statements like these, sadly even from some of my classmates, it makes me shake my head.

During my years as an ER tech, I worked primarily with the nursing staff, and developed mad respect for the profession.

As the saying goes, be nice to nurses. They keep doctors from accidentally killing you.

Truths About Anatomy Lab

2010-09-14T00:01:00.003-04:00

1) Anatomy lab makes you hungry. People claim it's the fumes; I happen to try to remember structures by identifying what type of food they resemble, but either way, everyone leaves lab famished.

2) Anatomy lab makes you lose your appetite. Despite having a pretty iron-clad stomach, nothing really induces nausea like swallowing a big gulp of formaldehyde and phenol while leaning your head into an empty thorax in a vain attempt to find yet another vein.

3) Anatomy lab is delicate. It only took a few attempts at scissor spreading fascia or trying to dig out a tiny vessel to confirm that I will never become a surgeon.

4) Anatomy lab is barbaric. Two words: bone saw.

5) Anatomy lab is terrible. You spend hours of your afternoon in a windowless dungeon trying to memorize an unfathomable list of terms while digging out never-ending globules of fat, only to realize that the tiny structure you're looking for is buried in fat. The fat you just ripped out.

6) Anatomy lab is incredible. In all seriousness, it truly is a privileged insight into the awe-inspiring complexity and beauty of the human body. Add the fact that a person made the choice to donate their body to further our medical education, and this rite of passage becomes all the more humbling.

*The image comes from Street Anatomy. Check it out.

**This post was written during time I should have spent studying anatomy.

The Circle of Life

2010-09-13T00:01:00.001-04:00

One of the biggest changes I've noticed so far between college and medical school is Block-based scheduling. In undergrad, you'd have an exam or two throughout the semester, and then one massive final to worry about at the end. In med school, we're tested every three or four weeks. While we're currently only in the midst of Block 2, I've already noticed some cyclical trends, especially in terms of the weekends.

First Weekend:

We've barely covered anything this week, and we have so much time before the next exam. Hakuna Matata!

Second Weekend:

Wait... I have to learn the entire citric acid cycle again? Um, where did I put that biochem book?

Third Weekend:

Don't sneeze so loudly, this is a library! I have 800 more flashcards to memorize!

Fourth Weekend:

Post exam bliss. That wasn't so bad, right?

Just rinse and repeat for the next two years.

More Data on ER Overcrowding

2010-09-09T12:00:00.000-04:00

Several news outlets have picked up on a new study from Health Affairs that details how emergency departments continue to replace private physicians as the source of acute care in the US. Decreasing access to primary care drives up visits to the ED, leading to longer waits, overcrowded departments, and higher cost. Read more about the study here and here.

"The Sun. It is Making Much Warmness Today!"

2010-09-09T00:01:00.000-04:00

From the same comic genius that brought us a far more descriptive pain scale*, comes The Four Levels of Social Entrapment. I highly recommend you check it out.

Even after orientation, those first opening weeks of medical school saw the same conversation (Hi! What's your name? Where are you from? Where did you do your undergrad?) repeated ad nauseum, often with the same person. By this point, much of the initial awkwardness has subsided, though I'm embarrassed to say there are still several classmates whose name I do not know.

I wish I could claim these are people I haven't yet managed to meet. But no. While I'm great with faces, I'm terrible with names, so there is a distinct population of students who greet me with a chipper "Hi Second Shift!" each morning before class, only to receive a tentative "Hey...you..." in reply.

Since we're beyond point where it is socially acceptable to ask someone's name, I think I'm just going to have fudge it for the next four years.

*In case you need proof of hilarity:

Scale ranges from "I am completely unsure whether I am experiencing pain or itching or maybe I just have a bad taste in my mouth" to "You probably have Ebola."

I'm Not a Med Student, But I Play One On TV

2010-09-08T07:43:00.005-04:00

"Oh, you'll see him again for the male genital exam."

So explained my Clinical Skills mentor after one of my classmates finished interviewing her standardized patient. SPs - actors paid to present with a particular history and illness meant for us to uncover - are the wading pool in which we dip our toes before interviewing (and yes, examining) real, honest-to-goodness patients in just a few short weeks.

When I worked in the ER, I had few problems establishing a good rapport and asking questions of my patients. SPs are a little different. Maybe the video camera and 12 other people watching the interview have something to do with it, but more likely is the fact that we're asking questions and obtaining information without any idea how to act on it. I know that will come in time, but for the moment it feels like we're acting just as much, if not more, than the SPs.

I suppose you could say that we're learning the importance of projecting confidence, of affecting the right demeanor with open body language and maintaining eye contact.

Put another way, the motto could be "fake it 'til you make it."

Loving My DTs

2010-07-26T06:30:00.001-04:00

Real delirium tremens, as in the hypertensive, tachycardic, febrile hallucinogenic state of not knowing who, what, or where you are as you trash wildly against the restraints barely holding you to the stretcher while withdrawing from alcohol? Not fun (or so I imagine).

But the beer Delirium Tremens, as in the 9% ABV Belgian pale ale sipped while sitting out on the patio? Fun.

While I certainly miss working in the Big City ED, suffice it to say I am enjoying my time off before school starts next month.

Happy summer all!

Anyone Can Be A Hero

2010-07-12T00:01:00.000-04:00

This summer, Hollywood action heros will dodge fireballs, take punches, and survive high-speed chases while saving the day.

In comparison, I look pretty lame. As an ER tech, I took vitals, drew blood, and maybe helped bandage a few wounds. As a med student, I'll start off doing even less, mainly memorizing facts and looking things up.

But one way people without any training or special skills can help is by giving blood. Every two seconds, someone requires a transfusion, and the need for blood often spikes during the summer months.

By donating just one pint of blood, you can help save up to three lives.

Be a hero. Save a life. Give blood.

Yeah, He's Faking

2010-07-07T00:01:00.000-04:00

I'm a big soccer fan, but even I find the diving ridiculous. The similarities between international soccer stars and ER fakeurs, however, makes me laugh.

Beware the 1st of July...

2010-07-01T12:05:00.003-04:00

As reminded by Ambulance Driver, today is the first day of residency for brand new interns in hospitals across the country. To the newbie MDs and their patients, good luck!

Finale

2010-06-28T00:01:00.001-04:00

Looking back, it's funny to realize that my interest in emergency medicine began with a flyer for an EMT certification course. In the years since pausing at that random campus bulletin board and thinking, Hey, that could be interesting, I've learned a lot, while simultaneously realizing how very little I know. But somewhere between taking care of trauma patients and listening to drunken renditions of '80s power ballads, I realized that this is what I want to do with my life.

And in just a few short weeks, through incredible good fortune and thanks to the support of my family and friends, I'll move even closer to that goal by starting medical school. Unfortunately, the trade off means that my time in the Big City ED, and the stories that came with it, must come to an end. I'm really going to miss the wonderful people I've worked with over the years.

I'm sure med school will produce one or two amusing stories of its own, which I may try to post from time to time. To everyone who has stopped by this blog, thanks for reading. It's been fun.

A Match Made in ER

2010-06-24T00:01:00.000-04:00

She certainly was a keeper. Vomit covered hipster plaid shirt, mouth agape with spit/drool leaking out, glasses askew, head propped up with pillows to prevent falling into the emesis basin. A definite 10/10 hottie.

Which is totally why I wrote my number down on the nasal trumpet before inserting it through her nostril to help maintain her airway. That way when she sobers up tomorrow morning and pulls it out, she can call me, and our courtship can officially begin.

Rough Start

2010-06-21T00:01:00.000-04:00

Watching the charge nurse running down the hallway, pushing a crash cart in one hand and yelling into a phone held in the other is never a good thing. Minutes after I had punched in, I followed the commotion to a cramped exam room, where an elderly patient who presented with shortness of breath had suddenly gone into cardiac arrest.

Crammed into possibly the smallest room in the department, we had senior resident at the head of the bed intubating, a tech on one side doing compressions, a nurse pushing meds, another nurse documenting, the attending shouting orders, another tech standing by to relieve compressions, respiratory elbowing through to set up a vent, an intern attempting to start a central line, and another nurse prepping drips.

The patient, who not an hour earlier had walked into the ER, was lying on the stretcher with clear plastic tubes sticking out of her mouth, both arms, and groin. The attending suspected a PE and ordered thrombolytics, which meant by my turn for compressions, blood spilled out of the ET tube, and splattered over my arms and face shield while RT suctioned. Shocked twice with no success.

An hour later she was pronounced, and, covered in blood and drenched in sweat, I shuffled out of the room with the rest of the team, listening to the patient's daughter sob in the chaplain's arms down the hall.

Not the best way to start a shift.

Sad, But True

2010-06-19T00:01:00.002-04:00

Over the past five years, ER visits for prescription painkiller abuse is up 111% according to new figures from the CDC, as reported by Reuters. Oxycodone alone caused over 105,000 visits, an increase of 152% over the same period.

Clearly, there is no easy solution to this problem. Substance abuse problems destroy lives - a fact lived over and over again in ERs across the country. At the same time, painkiller abuse ties up ER beds and adds to healthcare costs. I don't have the answer, but hopefully there are people much smarter than I am working on this issue.

Magic Spray

2010-06-18T00:01:00.000-04:00

Working at a Level 1 trauma center has introduced me to many kinds of life-saving equipment. The ER staff is quite versatile with rapid infusers, thoracotomy trays, and Glidescopes, among other things.

What we don't have is Magic Spray.

Magic Spray, for those who aren't glued to the World Cup every four years, is an apparently miraculous compound liberally applied to footballers following a seemingly agonizing injury. After rolling around in the fetal position in an attempt to draw a foul, the players are escorted off the field by medics who whip out their trusty aerosol cans and suddenly return mobility to the lame.

So here's my question: if it works for the fakeurs of elite international soccer, why don't we try it in the ER?

Pain in your knee for the past 10 years that you decided you could no longer handle at 0330 in a Saturday? Well, we're not going to prescribe you narcs, but if you step back here for a second and - don't tell anybody - we have a little something something that's all the rage among European athletes.

Then a quick spritz of ethyl chloride, or lidocaine, or norMAL SALine, or whatever, and send them on their way.

GOOOAAAALLLL!

Good Idea

2010-06-17T00:01:00.000-04:00

Pt: "I've been feeling a little off for most of the day, and finally decided to get checked out. Better safe than sorry, you know?"

Turns out it was a pretty good idea. No chest pain, but EKG showed a MI and iStat troponin came back hugely positive. Rushed up to the cath lab and ended up doing pretty well.

There are plenty of BS complaints in the ED, and plenty of people who feel sheepish coming to the emergency room for what turns out to be a negative work-up. I wish there was a simple way to predict in advance what's emergent and what isn't, but cases like these prove that it really is better to be safe than sorry.

You Know How To Breathalyze, Don't You?

2010-06-14T00:01:00.002-04:00

Just pucker your lips and blow.

At least that's how we tried to explain the process to the extremely intoxicated teenager who arrived in the ER covered in vomit over the weekend. Poking him with the straw, I asked him to blow out like he was blowing out a candle.

Eyes still mostly closed, head perked up a little, he affixed his lips to the straw, but rather than blowing out, he started sucking.

Hard.

Said the medic, "Not that kind of blow," as he continued to go to town.

I half expected the breathalyzer's LED screen to light up a smiley face as it got more action that night than any of the rest of us.

Extreme EM

2010-06-13T09:25:00.002-04:00

From the New York Times, another article detailing the incredible job performed by Medevac teams operating in Afghanistan.

This Just In

2010-06-10T00:21:00.004-04:00

BLACKHAWKS WIN!

Playing the Odds

2010-06-09T00:01:00.000-04:00

Every so often, the stars align and I'm lucky enough to work with great nurses, great doctors, and great patients. Two out of three ain't bad, and even just one out of the three can usually get me through a shift. One of the things I love most about working in the ER is the variability, which, unfortunately, means every so often I'll get none of the three. And that can make for a very long 12 hours. When that happens, you suck it up and remember that things can only get better tomorrow.

Stomach Pumping

2010-06-08T08:30:00.003-04:00

It may be ugly, but it's effective.

Using an Ewald tube, also known as stomach pumping, isn't all that common. For ingestion patients, activated charcoal or a nasogastric tube are much more popular options, at least in the Big City ED. But after ingesting a full bottle of Tylenol less than 30 minutes prior, our patient last night won herself the tube.

Actually two tubes, if you count the intubation. One of our veteran nurses recounted how stomach pumping on conscious patients was fairly common back when she first started. I'd prefer the etomidate and sux myself.

The Ewald tube resembles a clear plastic garden hose which is inserted through the mouth and advanced into the stomach. Even with the patient sedeated, it didn't look pleasant. Saline is rushed into the tube from a large bag suspended from the ceiling, filling the stomach with water, which gravity then drains out to an empty bag.

At least the pill fragments rushing through the tube looked much better in the bag than in her liver.

Trauma On Ice

2010-06-05T12:09:00.003-04:00

Chicago Blackhawk Duncan Keith after losing 7 teeth in one game.

Not sure how many other rabid hockey fans there are out there, but with the Stanley Cup Finals now tied up, this article about hockey doctor stories is pretty timely. Not exactly stories from the emergency room, but close, and equally (if not more) awesome.

Known Unknowns

2010-06-03T00:01:00.001-04:00

With just over two months to go, I'm getting pretty excited about starting med school this fall. Excited, and at times, a bit terrified. The sheer amount of knowledge I'll be expected to master, and the responsibilities that come with it, can feel pretty intimidating.

With those thoughts in mind, I have to thank one of our residents (we'll call him Roy G. Biv, MD) for allaying some of my fears. To be fair, Roy's a very smart guy, a very nice guy, and a good doctor. He just cannot function in the ED, which is unfortunate given that he is completing a residency in emergency medicine. Easily overwhelmed, Roy tends to get flustered quite easily.

So I'm assuming it was the stress of juggling multiple patients, and not temporary color blindness, that prompted him to open the IV cart, remove on of the blood tubes, walk over to me, place the tube in front of my face and ask:

"Is this a blue top tube?"

Yes, there are several colors of tubes to choose from, but we're not talking about a Crayola box of 120 crayons. I could have been a smartass and argued that it appeared to be more of a ciel or even robin egg blue, but instead I simply confirmed that the tube was, in fact, blue. As opposed to red, pink, green, light green, gray, or any of the other non-blue-colored tubes we use.

I may be terrified at how much I have to learn going into med school, but at least I have my colors down.

Tough Old Bird

2010-06-02T00:01:00.002-04:00

"My pain? Try 20 out of 10, man. I stubbed my toe real bad!"

"I twisted my knee last month and it really hurts and I can't walk, so I decided to come in at 0300 because I lost my pain med prescription."

"I was in a minor fender bender 10 years ago that left me with chronic, debilitating, whole-body pain that only responds to Dilaudid."

Needless to say, we get statements like these all the time in the ED. And, sadly, over time they can make you a little skeptical about patients overstating their actual level of pain.

So imagine our surprise last night when a very poised older lady walked up to triage with an obviously dislocated shoulder and calmly asked if a doctor might take a look at it. Apparently she fell in the morning, but managed to finish packing her bags, board an airplane, fly to the Big City, and return to her home before deciding that she might need some fixing up.

When asked how bad her pain was, she replied, "Oh, not awful. I've had worse." She initially refused pain meds for the reduction, and didn't even wince as the intern tugged, pulled, and rotated her arm back into place.

Badass, Ma'am. Badass.

Oops

2010-06-01T00:01:00.001-04:00

Well, it took me a few years, but I finally dropped my first blood tube and sent blood glass flying all over.

The slow clap initiated by my colleagues was a nice touch.

Looks like my plans to start juggling blood culture bottles to entertain waiting patients will be put on hold indefinitely.

Happy Memorial Day

2010-05-31T00:01:00.000-04:00

To all the men and women who gave their lives in service to their country, thank you.

Strong Work

2010-05-30T08:52:00.002-04:00

While reading one of WhiteCoat's recent posts, I came across his use of the phrase "strong work," and chuckled. It's a common refrain in the Big City ED (used both sincerely and sarcastically), but whenever I use it outside the hospital, people look puzzled.

Glad to see we're not the only keepers of the sacred word.

You Think EMTALA is tough...

2010-05-29T00:01:00.001-04:00

...try drawing the line between treating injured civilians and expending precious military resources in Afghanistan. The New York Times recounts the story of a 5 year old boy bitten by a snake in Helmand Province who managed to survive thanks to the US military. A fitting reminder this Memorial Day weekend to thank our men and women in uniform for their service.

Bad Boys Bad Boys, Whatcha Gonna Do?

2010-05-28T00:01:00.001-04:00

The good news: With the number of police officers present in the ED last night to arrest/guard our unusually large population of felony-prone patients, the Big City Hospital was probably the safest location in the state for several hours. We estimated there was enough firepower in the department to repel a small battalion from attacking the ED.

The bad news: With the number of police officers present in the ED last night, I'm pretty sure the rest of the state was subject to mass looting and pillaging.

When I'm Sixty-Four

2010-05-28T00:01:00.000-04:00

When I first started working in the ED, patients would frequently comment on how (inappropriately) young I looked. "What are you, 14" was a common refrain.

Today, over three years later, I can proudly state that a patient guessed that I was 17 years of age. Still well below the mark, but at least I appear to have aged the correct amount, and can almost pass as a high school graduate.

At the rate I'm going, I should finally look like an attending by the time I'm in my mid-sixties.

My Future Colleagues

2010-05-27T00:01:00.000-04:00

Said the violently drunk college student as he was transferred off the EMS gurney: "I'm pre-med!"

Said the high girl as she trashed about the stretcher: "I'm a nursing student!"

Coming soon to a hospital near you!

Bizzaro ED

2010-05-26T00:01:00.000-04:00

With my time in the Big City ED winding down and med school on the horizon, I recently took a trip to check out the institution that will soon be my new home for the next four years. (Spoiler alert: I had a great time!)

During the visit, I was able to shadow in their ED for a few hours. It's a beautiful facility, relatively new and much bigger than where I work now, but it felt like I had stepped into some sort of parallel universe. On one level, everything was the same - drunk patients were yelling, trauma patients were packaged for CT, the waiting room was full of patients anxious to be seen - but every little detail seemed different. Equipment was similar, but from other manufacturers, while protocols, uniforms, and even the local accent were all just a little bit off.

In any event, my next two years will be spent hitting the books, so these were nothing more than interesting observations. Knowing where to find a blood culture bottle is going to take a back seat to locating an obscure anatomical structure.

Still, it was great to peak into the future a bit, and realize that in just a few short months, my med school adventure will finally begin.

Apocalypse Now

2010-05-25T14:00:00.000-04:00

Walking past the hospital this afternoon, I passed a gentleman relieving himself in public. Not behind a dumpster, not in some back alley, but literally while walking down the street. Letting it all hang out, apparently enjoying the summer breeze.

I think I just witnessed the end of civilization as we know it.

Suicide

2010-05-24T00:01:00.000-04:00

Suicide is truly awful for all involved. Over the weekend, we took care of a patient who tried to end his life by jumping out a window several stories up. His attempt was not successful.

Instead of ending his life, he arrived in the ED with bilateral open tib-fib fractures, a closed pelvic fracture, several rib fractures, and multiple fractures up his spine.

He was in agony.

In the ED, where claims of suicidality are so often used an excuse to spend the night in a hospital bed or to seek attention, the temptation towards cynicism can be great. But for those who truly feel they have no other option than to end their own life, my heart breaks. Often, we're lucky, and ingestions can be managed and self-inflicted wounds repaired. But this gentleman, already clearly suffering, will now go on to endure an agonizing rehabilitation from which he will likely never recover.

Summer Breeze

2010-05-23T00:01:00.002-04:00

I'm really going to miss the ER.

We had a very, very rare occurrence the other night: it was slow. As in, nobody in the waiting room. Nobody in the hallway. Empty rooms with nice, clean stretchers and nobody on them. So what did we do?

One of the nurses had his guitar, and we went outside and enjoyed the fresh air of a nice summer evening while listening to music in the ambulance bay. Maybe not everybody's idea of a good time, but for us, it was perfection.

Speaking of Helmets...

2010-05-22T11:30:00.000-04:00

Wear one. Bicycle helmets have been shown to reduce the risk of head injuries by 88% and facial injuries by 65%, according to this article from the New York Times. Believe me, it's worth the investment.

Let Them Eat Cake

2010-05-22T00:01:00.000-04:00

With my time in the ER rapidly approaching an end, some goodbyes have already begun. I've developed great relationships with patients and staff alike over the years, and I know I will be sad to leave.

Jose Cuervo, long one of my favorite chronic EtOHers, known equally for his slurred, off-tempo renditions of great 80s power ballads and his nearly 600 visits to the ED over the past few years, sadly has not graced us with his presence lately.

Earlier in the year, I had hoped he would reach the coveted 600 visit mark before my employment came to an end. To celebrate the occasion, I even planned to commission a cake in the shape of the hospital turkey sandwiches he so loves.

Whether he's back in jail or has simply migrated out of the Big City for a while remains to be seen, but it looks like Jose and I won't be able to have our cake and eat it, too.

Head Injury Month

2010-05-21T09:18:00.003-04:00

As usual, nobody says it better than the folks at The Onion:

Nation's Bicyclists Remove Helmets For Head Injury Month

MAY 20, 2010 | ISSUE 46•20

CHICAGO—In celebration of concussions, cerebral contusions, and other forms of blunt head trauma, bicyclists across the country removed their protective helmets Monday for National Head Injury Month. "It is an honor for me to commemorate this wonderful, wonderful month," said NHIM organizer John Harris, who made the announcement while simultaneously riding his bike, blasting Danzig-era Misfits on his iPod, and veering wildly in and out of traffic. "It is an honor for me commemorate this wonderful, wonderful month." Cyclists observe National Head Injury Month each May, immediately following their recognition in April of Flailing Uncontrollably Through the Air Month.

Welcome to the ER

2010-05-21T00:01:00.000-04:00

I've often thought of what kind of crazy old person I would like to become. Slightly dotty? Borderline offensive? Completely off my rocker?

Thanks to my 85 year old raging UTI patient from last night, I now have a new potential model.

Strong and combative enough that he needed to be restrained, we learned that his entire vocabulary consisted of only two words, shouted at the top of his lungs to anyone who passed by the stretcher, and they rhymed with "cluck you."

We briefly toyed with the idea of leaving him in the waiting room as our new greeter for drug seekers and fakeurs...

Happy EMS Week!

2010-05-20T00:01:00.003-04:00

To all the EMTs and medics working on the front lines of emergency medicine, thank you and happy EMS week! We're fortunate to work with some great EMS professionals in the Big City ED, and I'm glad to know they're out there if I ever need them.

For those who haven't, be sure to check out Medic 22 and Ambulance Driver, two of my favorite EMS blogs!

(Also, I don't know if you're still out there EE, but I miss your blog!)

Balance

2010-05-19T00:01:00.001-04:00

She came to the hospital to die in the ED. Concerns about inadequate pain management at the nursing home prompted family members to call 911 in her final hours, and EMS delivered her to the critical care area. With agonal respirations and a heart rate in the 30s, she was given medication to make her comfortable, and left to die with her family in peace.

In my experience, patients rarely die in the ED. The majority come in mostly or completely dead, some are stabilized long enough to make it to the unit or the OR, and a very small number truly die in front of you. I always remember the later. At least in this case the woman lived a long life, and died with family at the bedside, even if it was in a busy emergency department and not in the comfort of her home.

After a few years of working in emergency medicine, I still find these experiences among the most difficult to deal with. I know that she was not in pain, and that her family was present, but in an environment where we're always trying to "do something," simply standing by and letting nature take its course can leave me profoundly sad, even if it is the right thing to do.

Maybe it was some sort of karma when, later that same shift, I was asked to bring a very pregnant woman up to maternity. Already contracting and getting ready to pop, Mom smiled while Dad proudly shared the name of his soon-to-arrive firstborn son. I'm not a big, circle of life kind of guy, but it was a nice ending to a long day.

Man's Best Friend Redux

2010-05-18T00:01:00.000-04:00

It's not every day your dog decides to bite your nipple off.

My distinctly non-medical family often questions why I would choose to pursue a career emergency medicine, and I usually reply that the ability to deliver statements like the above in a professional context plays a large role.

According to the patient, she was lying in bed, minding her own business when Snoopy decided leap out of nowhere and take a bite out of crime... or at least breast tissue.

She earned bonus points for bringing in the nipple, piercing and all, but sadly her hopes for reattachment were ultimately in vain.

Seniors

2010-05-17T00:01:00.000-04:00

The weather is getting warmer, the sun is getting brighter, and graduation season is upon us. Before graduates don their caps and gowns, however, they generally all pass through some sort of Spring Concert/Class Day/Senior Week bacchanalia that inevitably leads a handful to pass through the ambulance bay doors.

The results typically range from the slightly amusing to the tragically trashy and the nearly intubated.

Over the weekend, however, amid the stream of 20-somethings pouring into the ED, a very inebriated septagenarian rolled in shouting obscenities.

Observed the triage RN: "Gives a whole new meaning to Senior Week."

Reasons Why I Love My Job

2010-05-16T00:01:00.000-04:00

Walked into the ED the other night absentmindedly whistling the opening bars of the eminently catchy Your Love - "Josie's on a vacation far away..."

Both a doctor and a patient immediately responded by whistling the next part, "Come around and talk it over."

Hole in One

2010-05-15T00:01:00.000-04:00

Golf balls: great for putting up ramps and through windmills, less great in the rectum.

Adding Insult to Injury

2010-05-14T00:01:00.000-04:00

Sometimes in life, when it rains, it pours.

Take, for instance, the case of a patient who was discharged from our fast track area and promptly hit by a police car while crossing the street after leaving the hospital.

Back in the ER as a trauma patient only minutes after having his original minor problem fixed, he was lucky enough to avoid any significant injuries, but still managed to receive a ticket for jaywalking.

Truth or Dare

2010-05-13T00:01:00.001-04:00

Pt: Is it true what they say about ER nurses?

RN: What's that?

Pt: That you're all wild and sleep around?

RN: ...

Man's Best Friend

2010-05-12T00:01:00.000-04:00

I've said this before, but apparently the point bears repeating, so I'll say it again: Do not go up against a police dog.

You will lose.

Badly.

Every time.

Cool

2010-05-11T00:01:00.000-04:00

Patient arrives in the ED with a non-cardiac related complaint. The nurse goes in and gets the story, the doctors go in and get the story, I go in and get some bloodwork, the patient waits for transport to take her for some imaging studies.

Patient returns from her scan, stating she "feels funny." While hooking her back up to the monitor, the alarms start ringing. Assuming that I'll find jagged green lines caused by artifact, I look up to see V-fib on the monitor, and look down to realize the patient is coding.

Yelling for help, I start compressions. Patient gets tubed, defibrillated, and shocked back into sinus tach. An ICU team arrives shortly thereafter with a cooling unit, dropping the patient's core temperature a few degrees.

Days later, I learn the patient walked out of the hospital with no deficits.

Not a bad day at the office.

Sorry... No We Can't

2010-05-08T10:27:00.000-04:00

Patient who was npo while waiting for surgery: "If Obama can pass healthcare, you can get me some water!"

Do Not Pass Go

2010-05-06T00:01:00.001-04:00

If for no other reason than the emergency department is an acute care medical facility and not a local watering hole, hospital policy states that intoxicated patients are not allowed visitors.

This remains the case even if one of the patients is "like, totally your best friend in the entire world" and you "just know that she'd, like, really feel better" if you were at her side.

It also remains the case even if, in addition to being a patient's bff, you proudly volunteer in the hospital once a month.

Leaving the hospital, going home, and returning to the ED with your volunteer polo shirt will not, I'm sorry to say, grant you any special privileges.

Put the Camera Phone Down

2010-05-05T00:01:00.000-04:00

I'll concede that there is no sign in the emergency department that prohibits taking photos or videos with your cell phone.

There's also no sign in the ED prohibiting shooting people, but we don't allow that, either.

For those who may be unclear, let me spell it out - you cannot take photos of other patients during your ER visit. It violates patient privacy, it's creepy, and I'm guessing you wouldn't be too pleased if a video of you walking down the hallway with the back of your gown open showed up on YouTube.

A Mint Under Your Pillow

2010-05-03T09:40:00.001-04:00

Not getting enough of your ER fix in the actual ER? Then travel to Australia where you can stay in the Daddy Long Legs hotel, complete with its own ER-themed room.

"As the name suggests, it has something of a hospital theme, with an X-ray cabinet on the walls and faux blood-spattered canvas curtains. A patient's gown is found hanging up, while the pillows have "Doctor" and "Nurse" written on them. The bathroom comes with a bedpan and a cabinet full of surgical tools."

Sounds more than a little creepy to me, to be perfectly honest.

Saturday Night's Alright for Fighting

2010-05-03T00:01:00.000-04:00

Warm weather + weekend nights = trauma.

I mean, what better way is there to celebrate sunshine and warm breezes than by drunkenly pushing your baby daddy down the stairs, or seizing while riding your bike and falling on your head, or getting tazed by the cops while fleeing a robbery, or foolishly assaulting a bigger dude with his even bigger friends nearby, or sticking your fingers in the lawnmower?

My new idea for a public health intervention? Stick everyone in air conditioned rooms and just let them cool off.

Best Line of the Night

2010-05-02T00:01:00.000-04:00

Intoxicated patient: "Wait, what time is it!?"

SS: "Almost 9 o'clock sir."

Pt: "Morning or night?"

SS: "Night."

Pt: "Shit... I hate it when this happens. I haven't accomplished anything today!"

What was he planning on, balancing his checkbook?

A Simple Request

2010-05-01T00:01:00.000-04:00

Pt: "I got an awful lot of blood on my clothes in the accident. Any chance you could get them dry cleaned while I wait to be sutured?"

Full Moon Madness

2010-04-30T00:01:00.003-04:00

Several studies have been published that find no correlation between the number of psych complaints presenting to the emergency department and whether or not there is a full moon.

I call BS.

Highlights from this week's full moon include:

*Pt complaining of being continuously awake for a 3-day sex binge. Combative and violent, he was placed in restraints and fought off multiple rounds of medication.

*Pt complaining of pain s/p inserting a foreign body into a cavity where it does not belong.

*Pt brought in spitting, trying to bite staff, screaming "I'm going to give you AIDS."

*Pt reading a large print bible down the hall from another patient who claimed to have stolen a rosary while drunk on dollar store mouthwash.

*Pt brought for eval by police after erratically operating her motorized wheelchair - scootering under the influence?

*Immodestly dressed patient found at a college underwear party with big, heaping chunks of vomit in her hair.

When I was little I wanted to be an astronaut when I grew up; now, working an 8 or 12 hour shift in the ER sometimes feels like visiting a completely different planet.

All Dressed Up and Nowhere To Go

2010-04-29T00:01:00.000-04:00

Often, when a patient comes to the end of a long illness and is about to die, they seem sense that the end is near. As I triaged a lady brought in by EMS last night, she explained to me how she said goodbye to the nursing home for the last time as the EMTs wheeled her through the hallways. She sighed as she told me about seeing her dead husband, and how she was ready to be with him again. And although her eyes were sad and moist, she seemed at peace.

The only problem - she wasn't dying.

Brought in for an altered mental status workup, the patient had no other major medical problems apart from mild dementia.

It seemed a particularly cruel trick for the mind to convince itself that the end was near, and to live out the remainder of one's days convinced that each one was the last.

Little Shop of Horrors

2010-04-28T00:01:00.001-04:00

Walking into a new shift in the ER, you never know what the night will bring you.

After arriving last night, I wandered into the trauma room to discover the result of "arm vs. industrial equipment." Normally these kinds of incidents result in what can effectively be described as ground beef, but in this case the machinery had removed the skin from the palm to the bicep, exposing a remarkably clean view of muscles, arteries, and tendons all doin' their thing.

Later in the evening, an unfortunate older gentleman arrived via EMS. The patient fell at home, where he lived alone, four days prior and had spent the intervening time unable to get up. Covered in his own excrement, it was the ferociously foul odor that finally tipped off a neighbor to call 911. The smell was so bad it even turned a few seasoned ER stomachs. Of course, tragedies like this have a way of occurring only to the nicest people, and the patient was remarkably pleasant while being thoroughly decontaminated.

And then of course there was the guy brought in by police after being found masturbating on the sidewalk.