Sometimes medicine offers us wonderful, almost unimaginable gifts. Heart attacks that were devastating, life-altering events a few decades ago are now treated with expediency and skill that our grandparents couldn’t imagine. A couple of days pass, and the victim is home with stents in occluded arteries and directions to modify activity and diet. Pneumonia, once the “old person’s
friend” (so called because it took the aged to eternity), is far less …
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Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room:
Back in the good old days, medicine was what we liked to call “fun.” Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and …
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Alfred is 95 years old, and sits quietly in his wheelchair, rocking back and forth. His strength is gone, and his veins and tendons bulge through fair, translucent skin, stretched over muscles of long lost size and use. His greatest foe is gravity, which holds his lithe, bird-like form in the chair enough to cause sores on his hips, but only barely. It looks as if he might float away.
He remembers little, but …
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I remember the early trials of thrombolytics; not for stroke but for MI. During my residency, we were still comparing tPA with streptokinase. It was pretty incredible stuff. Now we’ve moved beyond that positively “medieval” method of treating heart attacks and have advanced to incredible interventions in coronary and cerebrovascular disease.
Furthermore, we are able to rescue more and more people from the brink of death with advanced medications and with …
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One of the terrible things about being a physician who has spent his adult life working in emergency rooms is that you have a certain terrible clarity about the dangers of this life. It’s why we’re forever pestering our loved ones with phone calls and texts: “Are you there yet!” Or telling the children, “Be careful! After midnight there are too many drunks on the road!” Met, of course, with …
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It’s August. I’m looking out the windows of our log house and across the immense variety of green leaves, on oak and birch, mountain laurel and sycamore, magnolia and honeysuckle. It’s a rain forest here. Indeed, after a long dry spell, we’ve had days and days of soaking rain, with breaks in the clouds so that the sun raises steam from the earth like water coming up in the garden …
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I’m in the midst of a run of shifts in the emergency department. I’m doing locums away from home. Last night, I left work at about 3:30 a.m. (My shift was 6 p.m. to 2 a.m.) It was busy — not “crazy busy,” just “normal busy.” I finished my last note, wrapped up the information about the one patient I was leaving behind with the valiant night doctor and headed …
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Some dear friends of mine, at Busy Community Hospital, are having a momentous day. Today is the “go-live” for their brand new, shiny EMR.
For those of you outside the hallowed, creaky halls of medicine, this EMR is one of the most widely used electronic medical records systems in America. It’s big, it’s expensive, it captures lots of data, integrates ERs, hospitals, clinics, labs and everything else. (Probably your cat’s shot records too.)
The problem …
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I well remember being bullied on the school bus. On many cold, wet mornings (a large portion of the year in West Virginia, by the way), I found my junior-high self sitting in front of high school juniors and seniors who turned their class rings upside down, then used them to hit lesser life forms on the top of the head in a whipping motion. Turning around in pain and …
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I was working a 6 p.m. to 2 a.m. locums shift a few months ago and was preparing to leave. There were about 15 patients in rooms and 15 waiting to come back. I asked the lone night physician: “Hey, do you want me to stay a while?” Her answer, defeated, was this: “No, don’t worry. It’s always like this.”
I packed my bag and headed to the hotel, still feeling …
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These days, I work most of my shifts about 45 minutes from my “house on the hill.” At one of those jobs, the day shift starts at 6:30 a.m. Which means I’m rising from my bed at 4:30 a.m. in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.
I lay out my clothes …
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Ah, EMTALA! The revered Emergency Medical Treatment and Active Labor Act! It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training. “And then the bad doctor sent the poor lady to another hospital because she couldn’t pay! And the King came and crucified him for doing it!” The end.
EMTALA, for the uninitiated, is …
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Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them. Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are …
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I’ve never been the doctor who yells. However, if you work in medicine, you’ve met him or her. I’ll call this physician “Dr. Barkus Yellby.” Dr. Yellby is angry. A lot. In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted. Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated …
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Many young physicians in training have asked me, quietly or by e-mail, “Is it possible to be a Christian and practice emergency medicine?” I think that they ask a good question, and likely for good reasons.
In their rotations, they have witnessed, first hand, life in the ER. They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors …
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I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following: “Follow up with your primary care doctor.” Or, if they didn’t have one, “Follow up in one week with a primary care doctor.” I laughed to myself. Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we …
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I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9 mm, in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC.
As uncomfortable as the whole experience was (and it wasn’t my …
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My most important patient requires my constant diligence. For this reason, I am seldom far away from him. Only a few minutes inattention and there will be problems. I cannot forget my patient; I am trained to attend to him constantly. I am a professional, and my patient is, ultimately, my customer and the customer’s service is paramount, I am told. I am reminded by policies and procedures as well, …
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I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs.
I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in …
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Like many boys born in the 60s, my heroes were often frontiersmen. I grew up watching the Daniel Boone television series, with Fess Parker. (I can hear the theme song in my head as I type.) I watched the Disney production of Davy Crockett, and had a comic book of the same. I never missed a chance to watch John Wayne die on the walls of the Alamo (also as Davy …
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