To Be Real

While making my rounds to vital my patients at the beginning of my shift last night, I came across an older, slightly unkempt-looking gentleman who struggled with opening the box lunch container. I helped him pop open the plastic, and as I checked his blood pressure, he asked me in a weary voice if I knew when he could go home. He had asked at least three different people, he told me while shaking his head sadly, but no one had given him an answer.

I told him that it was change of shift, but that as soon as the nurses finished giving report I'd find out what the plan was. I also grabbed him a blanket and a pillow to make him more comfortable. As I turned to leave, he grabbed my hand and thanked me for being "a real person." Patting myself on the back for providing good patient care, I felt happy to be a "real person" who treated my patients with respect and tried not to let them get lost in the shuffle.

It was only during my next encounter with the gentleman that I realized that the patient had a history of psych issues, and thought that 50% of the population were aliens.

Thank You For Choosing the Big City ED

Arrived in the ED before the start of my shift last night, and before I had even taken off my gloves, let alone punched in, I received my first F@$% YOU of the night from the charming gentlemen sporting 4-point restraints and the striking scent of eau de stale urine.

Thirty seconds or less from arrival? I'd say that's a new record for me!

Poker Face

Pt's young child: "Eeewww, Mommy, he's got spots on his pants! Did you pee your pants?!"

[Looking down at my scrub pants, whose undried water splashes were the result of vigorous hand-washing consistent with the hospital's hand hygiene best practices, with a mixture of chagrin and amusement]

Second Shift: "No."

Bad Romance

The other night, in the middle of a particularly chaotic shift, an attending asked me to pull the IV on a patient awaiting discharge. Grabbing some tape and gauze, I found the patient (not one that I had been taking care of) parked on a stretcher in the hallway.

"Hi Ma'am, my name's Second Shift, I'm one of the techs. The doctor asked me to pull your IV out so we can get you out of here and on your way home." Rather than expressing the look of relief that usually accompanies discharge, the patient instead reacted as if I had told her that I hate both puppies and rainbows.

Now, patients generally don't bring their A-game to the ER*. They're sick, scared, high, or hurt, and often frustrated about being stuck in a place they had not planned on visiting. Working in the ED, all the madness and morbidity is part of our daily routine, and at times it can become easy to forget the patient's perspective.

Nevertheless, while the patient inferred that "get you out of here" meant that I would be rolling her to the ambulance bay and pushing her into oncoming traffic, that's certainly not what I intended to imply. The patient became slightly agitated, demanding to know what doctor had decided to "throw her to the curb" and why "no one had told her anything." Despite multiple attempts at explaining the doctor was printing discharge instructions and on his way to explain her diagnosis, she would not calm down.

In retrospect, was my word choice overly-casual? Perhaps. Could it simply have been the last straw in what apparently had been a long an unsatisfying ER visit? Probably. Do I think the situation was a bit of an over-reaction? Yes. Should I be more on guard when approaching patients that aren't mine? Definitely.

I generally develop good relationships with my patients, so this episode was more surprising than anything else. I suppose I should be more careful in how I phrase things. In the meantime, though, I won't be expecting any gold stars from Press Ganey.

*The notable exception, of course, being the drug seekers, fakeurs, and people who literally have nothing better to do with their time than chill in the waiting room. They always give one hundred and ten percent.

Bottoms Up

I'll be the first to admit that there are plenty of stories of me making a fool of myself in the ER.

Back when I first started as a volunteer EMT, there were also a handful of embarrassing mishaps. I still cringe when I remember how I nearly fumbled a backboard with a patient strapped to it.

But at least I never planted my bum over a patient's face like this medic...

A New Record

I've seen more than a few lightweights drink their way into the ER, and I've babysat many of them as they sobered up in the drunk tank.

With the cold weather in full blast, it's not uncommon for patients to spend most of the night sobering up where it's warm.

But this weekend was my first experience triaging a drunk kid around 0100 (careful to avoid the vomit remnants in his stubble), only to find him still mostly out of it when I returned the next afternoon.

Spending 16 hours sobering up on a stretcher in a hallway is certainly one way to ring in the new year.

Auld Lang Syne

Happy New Year everyone! Many thanks to everyone who visited this blog over the past year. I wish everyone a wonderful 2010, and good luck on those resolutions!