Hard and Fast - That Emergency Life

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...

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 ...

Tonight is one of those nights.  I work the evening shift tomorrow, so I am trying to stay up.  My boyfriend is out of town.  It's just me and my dog and a bottle of wine.  So I write... About the physicians being human....   Remember back to the first post when I mentioned the physician that encouraged me to write my stories?  He is the first person I told that I was actually writing.  Tonight was the first night I gave two friends the link to specific entries.  Anyway... I can't sleep yet and I feel like writing.  I feel if I am to tell stories of the physicians and the moment I knew they were human, it was only right to start with the one who encouraged me to write... GS. Anyone I work with will know who I am speaking of.  He is a veteran.  Navy.  Probably something prestigious with a lot of medals that I don't know about.  His son is a Navy pilot, his daughter is awesome and he has two grandchildren...

I work a helluva lot more than I write.  Especially now that I am putting this in a blog format.  I am mindful that people who may one day read this do not do what I do.  They cannot fathom that I and my colleagues see horror every day.  Yet we shop in the same produce aisles and phony laugh at the same meet and greets. I also try to be sensitive to the people who I've worked with along the way and to those currently in my personal and professional life.  Even to those who have done me wrong or led me wrong, I am at peace with that.  It's not an excuse for bad behavior, it's an understanding of what emergency work really entails and what it does to a person.  Even through the heartache, tears and awful moments, I have learned a lot from the best. And a disclaimer... I'm not perfect.  I've made mistakes.  I have regrets. If we learn anything about That Emergency Life... it's that life is short.  To forgive.  To move one. ...

We been dancin' with Mr. Brownstone He's been knockin' He won't' leave me alone No, no, no He won't leave me alone Spoiler alert: Mr. Brownstone isn't a grumpy next door neighbor.  Back in 1987, Guns-n-Roses released the song on their album Appetite for Destruction .  The song was written about their heroin addiction.  Back in the 80's, we knew about heroin.  We knew how destructive it was.  We knew the terrible addictions and withdrawals it caused.  In 1995, we watched Leonardo Di Caprio depict what a withdrawal looks and feels like in The Basketball Diaries.    Heroin kind of went away for a while. Then certain governing bodies decided that "pain" was a vital sign.  Everyone had to rate their pain, 0-10.  Next came patient satisfaction scores and asking patients if their pain was assessed and treated.  Next came big pharma, pushing these medications... these drugs... without any care or forethought on how/if/when they cou...

I attended public school in upstate New York; about 100 miles north of New York City.  My high school had less than 800 students for grades 8-12 but we had a pretty diverse student body... different races, religions, etc.  Sure, everyone had their little group of friends, but we crossed into different groups and pretty much all got along.  I thought I was pretty well-rounded. And then I started riding on the ambulance in my hometown. The majority of people who call 9-1-1 are calling because they need help.  They are at their most vulnerable, asking strangers to come into their home.  Can you imagine vomiting for three days, still wearing the same clothes, not showering and asking someone you don't know to come get you off your bathroom floor?  Imagine watching, helplessly, as a loved one is struggling or dying in front of you... you have three numbers to dial and a bunch of strangers come into your most private space, into your life.  We see a lot ...

I delivered the placenta.  Said in the same way Baby said "I carried a watermelon" in Dirty Dancing. My shift was over.  I was heading to the lounge to collect my things.  My NP colleague came out of the room across the hall in a scurry.  "She's about to have a baby."  I didn't collect my things; I stayed to help.  We were already busy and we were running short staffed.  Besides, one of the coolest things one can ever do in life is witness a life being born.  The patient was a teenager.  She presented to the ED with her mother complaining of stomach pain.  Her mother was worried sick.  The patient spent a lot of time in her room and could barely stand or walk because the pain was so bad.  Mom was legitimately concerned for her daughter's health. The patient never told anyone she was pregnant. Mom was just finding out now that she was about to be a grandmother. A 17 year old about to become a mother, crying and saying "I...

27 year old male.  When you hear that, you have a picture in your mind.  I do too.  Strong, robust, healthy, athletic, smart.  Prime time.  The world yours to capture! I quickly looked through his chart.  Only one prior visit to our ED.  No medical history, surgeries, allergies or medications listed.  Being seen today for an abscess.  No big deal.  I've incised and drained many on many different parts of the body.  Yes, even breasts, scrotums and rear ends.  This guy was going to be in and out of the ED without a problem! Then I read his last visit.  He was seen for thrush.  Not common in a healthy 27 year old.  Now my investigator hat was on and I went into the room. This was not the robust man I imagined.  This was a frail, ill appearing man.  There were stains on his bottom where the abscess was draining.  His sweatpants too baggy and just fell over his bony knees.  This was not a well m...

Hard and Fast.  That's how you do appropriate CPR.  Hard and fast is also how working in the field of emergency medicine usually feels.  My first shift as an emergency medical technician was in August 2002.  I was going to save the world.  All people were good.  All people were created equal.  People were going to appreciate what we could do to save their lives.  I was only going to do it for a year and then go to PA school.  Emergency Medicine wasn't going to change me.  I was going to have a career... healthy relationships... a husband... children... a house with a picket fence and a dog... I was naive.   I still see the blue eyes of the old gentleman laying on the side of the road.  Staring up at me blankly.  My first trauma arrest.  He took a pickup truck doing about 55 mph into the driver side of his car.  His bloodied head laying on his wife's lap.   I see every pediatric code...