March 15, 2020. The luke-warm water burns my hands for a few seconds; maybe this is how a snowman feels as it disintegrates on the first day of spring. Soon, my fingers loosen, but the sensation is fleeting. I dry my hands, put on another pair of gloves, then clean the stethoscope I’ve been using for the last several patients. I’ve been told that these are single-use, that I should …
On the front lines of a COVID-19 assessment clinic
A medical diagnostic company recently posted the following tweet: “The best way to beat cancer is early detection. A full-body scan will provide you with a look inside your body and peace of mind.”
I wanted to type a reply, but I like to tell stories, and Twitter will only allow 280 characters.
***
A young woman sits on the examining table. Texting. As I approach her, she dangles her legs and checks …
Too many scans is bad medicine
“I have a riddle,” Paul says, as the dining room falls silent.
“You’re at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There’s a room upstairs with three lamps, labeled X, Y, and Z.
You can turn on and off as many switches as you want while you’re downstairs, but you can only go upstairs once. And once you’re upstairs, you …
The art of diagnosis is like a riddle
I’ve just discharged a kid with a cough, and there are no patients waiting to be seen. “I’ll be back,” I tell the nurse, as I slip away to the hospital kitchen and unlock the door. I steal two frozen grilled cheese sandwiches from the freezer and throw them into the microwave. Minutes later, I’m in the call room.
I take a couple of bites and can already feel acid rising …
Beyond red flags: Beware of black butterfly warnings
Alex and Edward Santos have just returned from a weekend away at their aunt and uncle’s place. They love it there. The couple is in their 20s and spoil the boys with late bedtimes, movies and video games, and home-made cupcakes with chocolate icing and sprinkles. It’s been a long break for Alex, who’s 15, and has been off school for a week. Now, his vacation is almost over, he …
A mysterious case of seizures in the ER
In the 1984 rock mockumentary This is Spinal Tap, a fictional band discusses the controversy surrounding one of their album covers. “There’s such a fine line between stupid and …” the lead singer says, realizing where they’d crossed the line of tastefulness.
His guitarist finishes his thought, “… and clever,” he says. In life, in rock and roll and in medicine, there is indeed a fine line between stupid and clever.
During …
There’s a fine line between stupid and clever in medicine
The two-page letter of complaint was typed on crested letterhead. The words “utter disappointment” jumped off the page, bold-faced and caps-locked. “The doctors left me to bleed,” she wrote, banging on the exclamation key as if she was firing lasers in a game of Space Invaders. “I was hemorrhaging, and they did nothing except pop in and tell me it would stop.” The tirade was directed toward me and the …
When the nurses’ work goes unnoticed in the ER
It’s early March. I walk quickly past the ambulance bay, shivering as the doors open. Paramedics push a stretcher into the hall as a limp body gasps for air.
“Doc,” the tired man says. “I need help.”
“What happened?” I say. “You look terrible.”
“My belly is killing me.” He grips his stomach. ”I’m going to pass out.”
His pulse is weak, his hands cold. A nurse inserts an IV and turns to me: …
Doing too much hurt this patient
John Grover is a nice guy. He’s fifty-five, short, a little chubby, and he has a neatly trimmed red beard. He’s the kind of guy whose eyes light up the moment you walk into the room; The kind of guy who remembers your kids’ names, their ages, and their interests. I’d met him a few times before. He’d come in once to refill his blood pressure medication because he couldn’t …
Fixation error can be deadly in medicine
Triage Note: Fish hook in eye. No bleeding. Tetanus up to date.
It’s a sunny weekend during cottage season. A young woman is rushed into the ER as she cups both hands over her left eye. She’s in shorts, and flip-flops, and she’s hyperventilating. Her friends follow, hands similarly cupped over their mouths. I read the triage note. I’ve never seen this before. I’ve removed dozens of fish hooks — it’s …
The case of a fish hook in the eye
It’s 1 a.m., and I’m afraid this guy is going to die. He’s gasping for air, hunched over a table as I poke his chubby back and try to find a rib. Oxygen is flowing through nasal prongs at six liters per minute, and it’s barely making a difference as his oxygen saturation hovers around eighty-five percent (it should be in the high-nineties.) He’s sick, but what’s more worrisome is …
He was fine when I discharged him, now he might die
I carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.”
One of them held the small urine jar up to a light and began unscrewing the lid.
“Don’t!” I said.
“Why not?”
“It stinks. You wouldn’t believe how much it stinks. We …
The abscess that surprised this emergency physician
It’s almost 7 p.m., and I’m handed the chart of a man in his sixties. “Can you see this one first,” the nurse says, “he needs an ultrasound.” I skim the triage note, which is often like reading the blurb at the back of the DVD. If it says “pain all over for eight months,” it’s not likely to be a hot new rental.
Frank Martin (name changed) has been sent from a walk-in …
The curious case of a swollen scrotum
Seconds after I arrive at the ER on a Sunday afternoon, I’m called to see an elderly woman who can’t breathe. She’s ninety-four, and gurgling for air. On my way, I pass two middle-aged women. They are hovering outside a nearby room, trying to get my attention. One gestures like a traffic guard as she tries to wave me into the room. The other throws up her hands as I …
I’m seeing a fifty-something with knee pain when I feel the curtain behind me erupt open. It’s Roland, my last patient, and his breath is at my neck: “Why are you being so difficult?” he says. “Why can’t you just give me the prescription?”
I turn, and wave my hand over Roland’s head.
“Call security.”
He’s swearing again, and I can hear security’s racing footsteps as a code white is called.
“I have nothing more to …
How prudent antibiotic prescribing lowers patient satisfaction
(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.)
Dr. Stephen Cluff is like Yoda. Judging by body hair, he’s more like Chewbacca. But he’s short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet’s voice. If I’m stumped on a case, I’ll ask him. If I’m pissed off about department politics, I’ll call him for advice. If I want …
A case of abdominal pain in the ER. And a surprising cause.
I’m pulling on my last elbow’s displaced wrist when a nurse pops in, and tells us a critical patient is two minutes away.
“Mind staying?” my colleague asks.
“Sure.”
Paramedics are hunched over the patient as she is wheeled quickly into the resuscitation bay. At the top of the bed, a mask is secured over her mouth and oxygen is pumped with loosely gloved hands. It isn’t helping — her skin is grey — like …
Paramedics saved this woman’s life. They are the true heroes.
It’s the beginning of October, it’s Sunday, and it’s been an uneventful shift thus far. However, in exactly seventy minutes, a patient that I’ve just seen — one that I think has nothing more than an upset stomach — will collapse and begin a fight for her life.
I’m at the nursing station scribbling on a chart when a lanky man leans over me, a toddler in his arms. He’s looking at the …
A patient encounter that almost pushes this doctor over the edge
Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He’s forwarded a letter of concern from a specialist from a different hospital. It’s about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick …
Respect your nurse. Your life may depend on it.
It’s October, and it’s beautiful outside; warm, sunny with a lazy breeze. Colorful. Two hours into my ER shift, I meet Bridgette, a 77 year old who volunteers four days a week. She arrived by ambulance, but walks easily, and feels silly for being here.
She sits comfortably on the exam table and tells me her story: Two hours earlier, she was gardening at the seniors’ center when she had a sudden sharp pain in …
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