And despite how busy it was this past month, it didn’t change one bit how I feel about this job. Judging by a few comments advising me to change fields, perhaps that hasn’t been coming across in my posting, but really, this past month has been pretty awesome. Sure there were some obnoxious patients, ones that want to make you pull your hair out (and yes, even fantasize about doing them bodily harm), but there were also plenty of kind, thoughtful patients and family members, ones that inspire you to work hard, put a smile on your face and drive you to do your best for them, both as patients and people. There was actually many times where I felt bordeline high at work, the dopamine and serotonin being released in my brain from some of these experiences was at very high levels indeed. And it wasn’t just from doing sexy adrenaline like procedure stuff either, it was from doing basic things, making a patient with the flu feel better with some fluids and tylenol, explaining to a family what was going on, helping them understand their loved one’s illness, being thanked for doing nothing more than listening.
The hospital I am working at now, is about an hour commute from where our program is centered, but I used to live out by this hospital for 4 years during medical school, so I know many of the surrounding communities, and the people that live in them. I was caring for this patient and family who actually resided a street over from where I lived. I had never met them before, but there was that natural comradeship of people sharing a geographical location. The cue for inpatient beds was hours long, so they had spent my entire shift in the ED, waiting for one, so I would check in on them every hour or so, just to make sure everyone was alright and what not. At one point we had talked about the neighborhood, and I had mentioned how I loved the hoagies from the place that was at the end of the block. Towards the end of my 12 hours shift, the nurse came over and handed me a hoagie, from my favorite place, saying it was from the family in bed 12. Totally awesome. Made my day.
It’s been almost a month since my last post, and that’s more a reflection of the busy holiday season, both at work and in personal life, than not having anything to write about. I in fact have a whole list of things to write about, that I jotted down over the past 4 weeks, but now as a little time has passed, the feelings I had at the time, are now faded a bit and the motivation to try to summon them up has somewhat flagged, so we’ll see what ends up getting posted.
So yes, it’s been a very busy holiday season. And it’s not just me saying that. The attendings were all complaining about it, much more so than the resident’s as honestly we don’t know better at this point in our careers. They were constantly remarking how they could never remember it being so busy, so backed up, the weekends and holidays just as bumping as the Monday afternoons. At one point, we were on divert for 4 straight days. Divert means that ambulances, unless it is something super serious and time sensitive, are supposed to take their patients to another hospital. It’s a great idea in theory, except when the entire region is on divert, then it doesn’t really mean anything. And brace yourself for the moment you come off it. Picture a scene in a zombie movie, those bloody corpses piling up against and banging on the glass doors, trying to get in. That’s what the impending flood of ambulances feels like the moment you come off divert.
“Our Lady of Perpetual Sepsis Nursing home, this is the nursing supervisor how can I help you”
“Hi, this is Dr. ERJedi, I have a man here from your nursing home with what appears to be a 2mm paper cut on his finger. I’m just wondering if I’m missing something or if there was another reason you sent him over”
“We though we should send him over because he’s on a blood thinner and we were worried he was going to keep bleeding”
“What blood thinner is he on?”
It was about 3pm and medics brought in this guy on a stretcher, covered in sweat, all rigid and tremulous, shaking his head back and forth shouting ‘Nope nope nope, not gonna do it”. I heard the medics telling the nurses “Yeah, his complaint is that someone put the voodoo on him and sold him to the devil”. Mmmmm hmmm, I see. The guy wasn’t combative per se, just resistive to treatment, not really wanting to get into the bed from the medic stretcher, in fact just kinda standing next to the bed… sorta bobbing and weaving, moving his feat back and forth, arms pumping up and down, kinda this Gangnam Style meets Techno Viking routine. In fact, as we watching his moves, waiting for security to arrive, one of the nurses started dropping a beat and shit got rather crunk for a hot minute. A B-52 and a 4 point later our hot steppa’ was all snug as a bug in bed. His brother, who had called EMS showed up and told us that when he saw him last night, he was perfectly fine and had just finished a shift at work. The guy had no past medical, never did drugs or drank, and in fact was quite religious. He told his brother he didn’t feel quite right this morning and over the course of an hour gradually went from normal to the rhythm machine that presented to the ED. Before leaving, the brother placed an open bible underneath the patients head. How sweet. A few hours later, our patient was awake and calm and pleasant. I sat down and had a little chat with him during a quiet moment, and learned that apparently, after his brother left he “went to the club with a woman I should have known better about”. Ah, the devil wears stilettos! Who knew!
Looking back, I sincerely feel that if the start I had introduced myself as a doctor AND a priest, whipped off my white coat, fanned at him forcefully shouting “DEMONS BE GONE” we might have saved this guy from most of his troubles. Of course, he then would have fainted and we would have head a trauma on our hands, so maybe it wouldn’t have been such a good idea.
You know there has been a lot of false alarms when your rhythm strips are feeding directly into the garbage….
Had an impressive patient this week. An 82 year man came in with foot pain. On H&P, turns out he had ever running 3 miles a day, ever day of the week except Sunday, because Sunday’s are for church, since he left the army almost nearly 60 years ago… By my quick count, that’s over 55,000 miles, in other worlds, he’s circled the globe on foot twice. Not bad for 82.
I’ve been on toxicology for the past month, which basically involves sitting by a phone for 8 hours a day waiting for someone to call the poison center. Got maybe 3 calls a week… super exciting. A nice break though, but it’s back to the ED in two days, so should hopefully soon have some interesting things to write about. In the mean time, on the way to work today, the woman walking next to me suddenly belted out to no one in particular ”HELL YEAH, BAKED MAC n’ CHEESE TOMORROW!” and then just kept on walking. Long live Thanksgiving.
People talk about burn out all the time in this field. I know I’m only two years into this, but I’m pretty sure it’s not the job that burns people out, its the asshole patients. Those people that are just unkind, cruel, self centered. I fully admit, that I have positively loathed some of my patients.
“Hey there, I’m Dr. X, how can I help you?” ”Fuck you, fix my arm” Ohhhhh kayyyy then.
But these people aren’t anything new. They exist in every ED. They suck your good will out and just pour it down the drain. But fine, whatever, I’ll deal. But everyone once in a while…. you get that one guy….
There is this guy that comes into our hospitals about every two months. Always an overdose of his calcium channel blocker, usually a half assed suicide attempt, always goes to the ICU, gets tuned up, set up for out patient support, psychiatric follow up, never goes, comes back two months later, rinse and repeat. The thing is though, he is the most racist, sexist human being I have ever met, or even heard of for that matter. Once he comes to, wakes up, he runs his mouth constantly, spewing forth the most vile things you’ve ever heard. When I was in the unit with him one time, he had this kind, sweet nurse, one of the good ones, whom he quickly sent out of the room by calling her a “cunt nigger”.
Everybody hates this man, loathes him, wishes one of these times he would just get it right and come in as a code blue. How horrible is that, to think that, and then having to perform life saving medicine on him. That’s what burns the docs and nurses out, that’s what eats at the fiber of your soul. It takes 50 happy, kind, thankful patients to replace one of the scars left by these horrible people.
I wish more than anything, we didn’t have to put up with it. I’ll treat you, quite happily, but only when you act like a human being. Fine, I’ll come back in 20 minutes and you can try telling me about your arm again. But nope, not allowed to do that, cause door to dispo times matter more. We have to take it, to the let the patient smear all their vile feces all over our faces, while we stand there and take it. THAT’s where the burnout comes from, not from the long hours, not from the over crowding, lack of resources, or what ever other factor experts say makes us burn out.
It IS a problem though, even in residency. A poster that was presented at ACEP showed that 50% of EM residents experience mild burnout, 25% of them have SEVERE burnout (Ironically, 50% of participants failed to respond to the follow up survey)
And deep breath. I’m not saying I am in any way burned out. Far from it. I am a little angry about it, but beyond that….well, just keep doctoring on, and doing my best to not stab these patients in the eye with a angio cath, at least for the time being. There are days when that is a distinct possibility. And I think I’m better than most at keeping my cool. One of my other residents almost came to blows, patient telling the resident “GIRL I WILL FUCK YOU UP IF YOU DON”T GIVE ME A SCRIPT FOR PAIN MEDS” and her in response… getting right in the patients face and going all calm and quiet Clint Eastwood like…. “Go ahead, hit me, I dare you”….. Yup, let’s just keep packin’ powder into that keg.
I’m not sure what I’m going to do about, other then just vent about it anonymously for the time being. And a good vent always helps. Ahhhh, much better.
On toxicology at the moment. Earlier this week, we had a 2 year old up at the children’s hospital. Parent’s brought him in because the kid was ravenously hungry. Ate a whole 20 piece chicken McNuggets and was still hungry for more. As part of the workup, the kid had a drug screen done, and sure enough, the kid tested positive for cannabis. Oh, and when the parents called their house, dad’s brother was pissed because someone had gotten into his Marijuana stash and made a mess of it. Kid, don’t know you know your supposed to bake it into brownies and not eat it plain? What are they teaching in pre school these days.