Somebody recently suggested that I put up a post describing a typical workday. I agreed that that might be interesting to some people, so here it goes. (To ensure patient confidentiality and to be compliant with HIPAA laws, specific details and any references to patient identification are omitted.)
I was prepared for it to be pretty busy, the day after a major holiday. Most people don’t want to go to the ER on Thanksgiving so they come in the next day. And, doctors’ offices are closed the day after forcing patients to come into the ER. Many times these visits can wait until business hours. Other times…
Surprisingly, we weren’t as busy as expected. My first patient was a sweet little lady who lost her balance walking to the bathroom just after getting up. She fell hard on her back and came in complaining of pain in that area. Not very good at providing details, obtaining information from her was a challenge. Anyway a CT scan of the neck showed a possible disruption at the base of the skull connecting the spine. (MRI scan ended up being negative) CT of the lumbar spine showed a new fracture on a vertebra that she had fractured just a month ago. She really needed to go to a nursing home to prevent these falls from occurring again. However she was hell-bent on returning home to be with her husband. Despite the efforts of myself and man of our staff, we could not change her mind.
My next patient was a very pleasant retired gentleman who came in with rectal bleeding. Fortunately his blood work came back normal and he simply only had some thrombosed (clotted) external hemorrhoids that I cared for.
Another sweet old Filipina lady with a feeding tube had been vomiting for the last couple days. Her CT scan and her blood tests showed no acute abnormalities allowing us to discharge her back home. We ER people get frustrated often when patients with very complicated medical histories come in with potentially serious complaints but end up having nothing significant requiring any intervention.
After those three rather ho-hum encounters, I was treated to a very pleasant yet very stoic gentleman who very slowly and gingerly walked into the ER with a pretty serious problem. He had hand-carved a piece of wood into the shape of a sexual object, hoping to surprise his wife with a gift that would spice up their sex life. He decided to test it on himself but said, ”It got away from me.” He had tried for three days to remove it himself but finally had to call in the troops.
Sparing the details, I was able to remove it after about 30 minutes of diligent and should I say, rather “messy” work.
Next up, I admitted to the hospital another very sweet, elderly lady with lymphoma who had a life-threateningly low blood count requiring admission and transfusion of red blood cells and platelets. I knew she wasn’t going to do well in the months ahead. It seems that in our business, the nicer the patient – the worse their luck.
As I was just about to sneak down to the cafeteria for a bite to eat, the charge nurse announced that we were getting a post cardiac arrest, return of spontaneous circulation/ROSC patient. It was time for all hands to be on deck. Like in most ER’s, our staff prides ourselves on providing the best possible care in the worst possible situations. That would be the case today again. I was so proud of an ER doctor colleague, the nurses, the pharmacist, the techs and the support staff for us resuscitating a lady who had basically died just 45 minutes prior. She had gone about 20 minutes without an adequate perfusion of her vital organs making her chance for any meaningful neurologic outcome nil.
I informed the patient’s husband and son of her grave prognosis despite her current status. They took it very well. I have had to meet with family members in this type of scenario now for more than 17 years. With each I do a little better job… but it doesn’t get any easier.
Shortly thereafter, the nurses asked me to go see a young woman with psychiatric issues who has been having increased stress in her life. Basically homeless and living in her car, we were concerned that she might be at risk of trying to hurt herself or others. After a thorough assessment including evaluation by the psychiatric emergency team and our social worker, we were able to discharge her with some resources that would assist her with her struggles.
Toward the end of my shift, there was a huge, loud and very disruptive situation down the hall. As it had been up until now a fairly mellow day in the ER, I asked myself “What the hell is going on over there?” It ended up being the husband of a woman who had fallen into a glass door while carrying some boxes. She sustained two lacerations to her neck causing extensive bleeding but she avoided the carotid artery or the jugular vein, making her the luckiest person in San Diego this day. Because of the heavy bleeding and the location of such, her husband thought she was dying and so therefore was freaking out. HIs yelling at the nurses made their job of caring for his wife exceedingly difficult. I’m amazed at how ER nurses keep their cool under the most stressful situations imaginable. Ask any ER doc and they’ll tell you: “We couldn’t do our job without them!” Mad respect.
This day represents a fairly typical day in the life of an ER doctor. We see periods of not much excitement mixed in with periods of tremendous stress, drama and variability of the human condition.
The demands on us are high but the rewards are greater.
