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Spoiler Alert: It Wasn't Just Dehydration

 I didn't see the triage note. I saw 31 weeks pregnant. Nausea and vomiting. Heart rate of 130s. Easy. Check electrolytes. Hydrate. Give meds to stop the vomiting.  Easy peasy. Nope! So this poor woman was an alcoholic. She was withdrawing. Before you get on your soapbox or look down your nose... Alcoholism is real. It, like other addictions, is a real beast. I did my best to pump the patient full of zofran, pepcid, ativan and IV fluids. Her CIWA (Clinical Institute Withdrawal Assessment) was as high as 34. She was at a very high risk for seizures. To give you an idea of the severity of her condition, she was admitted to the ICU - where the sickest of patients go. Inexperienced me would have had a lot to say. My perspective has changed a lot since then. In nursing school, we had to attend an Alcoholics Anonymous meeting. Eye opening. I have had so many patients on the spectrum of intoxication and with varying degrees of cooperation vs belligerence. I've had encounters with alc...
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Instant Gratification: Repairing a Skin Tear

The last post dangled a part two. I don't have the energy for it. That shift was the only shift I've ever cried after work. Work has never made me cry. I've been doing this since August 2002. I've never cried. That shift was emotionally and mentally brutal. Colleagues told me it was painful to watch. It was that bad. Instead, I thought I'd show you the "fun" side of things. Procedures.  In the ED we do all kinds of procedures. We remove objects from places they don't belong, we splint, we intubate, we put back together... just to name a few. The downside is that procedures take time. We live in a society that has put gold medals on throughput, how quickly you can get a patient out. Therefore, procedures can really mess up your flow. Sad, right? Here's a recent one I did.   As we age, our skin naturally thins. There are other reasons, like some medications, that can also contribute to this. It is not uncommon for elderly people to have thin skin and...
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It Comes In Three... or Does It?

 Yesterday, volume was relatively low. Stress was relatively high. My shift was 7 am - 5 pm. I run my side mostly by myself until the next NP or PA comes in at 10 am. For the first part of my shift, I had a pretty good MD attending who trusts my medical judgement and leaves me alone to do the right thing. He's available when I need assistance; otherwise, he's hands off. The first half of my shift, while balancing all other patients, this is what I did: I had an actively miscarrying young mother whose husband wasn't allowed in due to covid. Actually, she miscarried about 3 weeks previously at 9 weeks gestation. She was scheduled for a D&C yesterday, at a different facility, because even though she miscarried her body did not expel it. The night prior, she started having bleeding and cramping. She bled heavy through the night. She came in by ambulance. The charge nurse never triaged her or took her vitals. She put her in a room and left it for another nurse to do. Fortuna...
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What a jerk. What jerk?

He was a jerk. He was rude to the triage nurse. He was rude to the x-ray tech. He tried to be rude to me when I went in his room a second time. His story? He stepped on broken glass at 3am with bare feet and cut his foot. Over 6 hours later he decided to go to the Emergency Department.  The real story? When you have to suture someone up, they can't move, they can't go anywhere. You either talk to each other or there is a kind of awkward silence. It was indeed the real story... stepping on glass. Like so many other stories, there were a few more details. The night before, he got really bad news. He was really upset. He picked up a drinking glass and threw it against the wall, shattering it. He thought he cleaned it all up but quickly found out he missed a piece at 3am. One dressing held together by duct tape later and he went back to sleep. What a jerk, right?! Breaking glass. Being rude. The day before, he found out that "a loved one had passed". That's what he in...
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So Much More Than A Business

Some days I shake my head at the choices we make behind the curtain.  Some times I remember why. Yesterday, we watched hordes of people going in and out of a room crying over an intubated man.  Lung cancer had aged him beyond his years.  He was not healthy.  He was a respiratory arrest with a terrible lung disease.  He was intubated.  He coded... meaning his heart stopped.  Everything was done to revive him.  Hundreds of dollars worth of medicine to keep this man alive.  Resources were pushed into that room as other patients waited.  Every time he took a downward turn, weary nurses and techs dropped what they were doing and ran in. His family got word.  And I mean allllllll of his family.  They all showed up.  In and out of the department they went, taking up space in the hallway. We took care of over 180 other patients yesterday.  It seemed like a waste to keep pouring all of our resources into a patient who would...
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Meeting the Metrics - Sometimes or Some Times

Right now, it feels likes healthcare is all about "meeting metrics".  As someone on the front lines providing patient care, regardless of a person's ability to pay, it feels those metrics are ill-aligned with the realities of emergency medicine.  It feels that the executives who are  in charge of establishing the metrics and analyzing numbers and graphs have no concept of what really happens. My job is to fix the broken and treat the sick.  Yes, I can assess an ankle, order an xray, splint and give the person appropriate follow up in less than an hour.  That's easy.  However, sometimes my job is a lot more than things that can be quantified, assigned a number and plotted on a graph. Sometimes my job is taking care of the family as much as I take care of the patient.  Sometimes it is delivering life altering news, dealing with the heart broken, holding hands, drying tears.  Sometimes it requires cultural sensitivity.  Sometimes it entails ...
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