Are You Ready For Some Commercials?

I'll admit that I'm rooting more for great commercials than either team today, but I hope everyone has a great Superbowl Sunday. Be safe!

There Will Be Blood

Today, countless people are alive thanks in part to a stranger's choice to donate blood. Want to save a life? Visit the American Red Cross website and find a blood drive near you.

Spoiler Alert

Psych Pt: "YOU are going to DIE! We are ALL going to DIE."

SS: "You're absolutely correct. What's your name?"

Pt: "I am Death. I am the Grim Reaper!"

SS: "Which one is it?"

Pt: "Er, Death. No, Grim Reap... DeathGrimReaper! YOU are going to DIE!"

You Spin My Head Right Round, Right Round

Pt: "I was seen her in the ER last week for this problem, but they told me it wasn't a medical emergency and that I should follow up with my primary care doctor. So I made an appointment, but they told me I couldn't be seen for a month. I managed to get in when somebody canceled, but my doctor told me I would need to be treated by a specialist. I had that appointment today, but he told me that I needed blood work and a CT scan, so he told me to go to the ER to get them."

Something about this system almost seems wasteful and inefficient.

A Code in the Night

For the first time in what felt like a very while, there were no patients waiting to be seen at 0330.

My carts fully stocked and the trauma bay empty, I took advantage of the rare downtime to catch up on some readings for class. A nurse at the computer next to me shopped for some new shoes online, a resident and a med student huddled around an EKG looking for ischemic changes, and the sound of some large fans could be heard as the maintenance guys waxed the floors in the back hallway. Even the drunk bigot in the room farthest from the nursing station had finally fallen asleep.

And then the radio crackled for an incoming cardiac arrest four minutes out. A minute later, EMS arrived with a mid-30s male undergoing CPR. Journal articles, Ebay, CNN.com and EKGs were all set aside as the critical care area filled with more staff than was necessary. Nurses started more lines and drew up resuscitation medications, I grabbed the defibrillator pads (does anybody but House use the paddles anymore?), respiratory bagged, and the senior resident checked suction before intubating the patient. We cycled through a few rounds of compressions and meds, giving the med student a chance to practice real-life CPR, but there was nothing on the monitor, no cardiac activity on ultrasound, and no pulse without compressions. We continued long enough for the intern to be guided through a central line insertion, but with nothing left to try, time of death was called at 0352. Unwitnessed arrest, with no information on medical history.

Talking with some non-medical friends the other day reminded me of the emotional and dramatic portrayal of codes on television. In reality, life rarely imitates art. We all took notice of the patient's age, and felt bad that he died so young. We all felt terrible watching the patient's loved ones cry as the chaplain led them to the family room. But then we went back to work.

After cleaning up the body, I stuck around to replace the suction canister, grab a new ambu bag, and throw some new saline flushes in the IV cart. Gradually people drifted back to whatever they were doing beforehand, and resumed the countdown to morning.

Blast From the Past

Having grown up several hundred miles from the Big City, it's really only the occasional drunk student that I recognize in the ED. Last night, however, I had to do a double-take as I realized one of my freshman year chemistry professors had sat down to be triaged for a minor laceration. This guy was a fantastic teacher, and very well-liked by his students.

I don't know what scared him more - that a former student of his was now participating in his medical care, or how overly enthusiastic I must have seemed to him. Either way, it was clear he had absolutely no idea who I was. Regardless, it was still great to see him.

There's a First Time For Everything

I've seen patients vomit in the sink.

I've seen patients pee in the sink.

But I've never seen a patient shit in the sink. Until now.

Do people do this kind of thing in their homes? I really wonder what it is about the hospital, or the ER specifically, that people feel gives them license to act in such seriously strange ways.

The best part was the patient's reaction after I turned to him in shocked recognition and asked if he had, in fact, just shat in the sink.

Pt: "Yeah."

At least he didn't deny it.