I introduced myself to the family sitting anxiously in the private room away from the chaotic symphony of beeping monitors in the main ER. When I opened the door, four pairs of bewildered eyes landed squarely and intensely on me. I wanted to look away so as not to betray my own emotions but instead stepped in and introduced myself again — one by one making eye contact. After a …
Your son is dead. How will you remember me?
The stories are disturbing. A pregnant emergency physician assaulted in a hallway. A patient leaping from the bed, wielding medical equipment as a weapon against the care team. A security guard intervening in a tense waiting room confrontation late at night. Most people find the violence hard to fathom, but for emergency physicians, these threats are part of life on the job every day.
A new poll by the American College …
Violence in the emergency department puts patients and physicians at risk
All have to wait. As is normal with the busy ER, the ambient noises of machines, alarms ringing, painful moaning, and loud drunken outbursts permeate the department. It’s a controlled chaos.
But, a woman’s scream pierced my soul. Her baby eight-month-old boy laid limp in her arms. He’s already pale, lips blue, his chest not rising as it should with breathing — he is not responding at all. We wasted no …
There’s an ugly undercurrent that sometimes shows up in the emergency department: indeed all over the world of medicine. I’ve seen it in doctors and nurses alike. It’s a meanness, a smallness, a kind of moral judgment that can lead us to make poor medical decisions. Or it can simply make us poorer in spirit.
I remember the day I had a young man who was in custody. He was 18, …
Physicians need to learn to avoid moral errors
A number of major cities have seen shared e-scooters, or electrical scooters, take over their streets. It’s certainly popular with the riders, but it is creating waves with a lot of critics as well. In Portland, Oregon, there are four companies trialing the scooters over a several-month period. Driving around my city, I find that we are being inundated with scooters being used on the sidewalk, on the streets, in …
An orthopedic surgeon’s take on the e-scooter craze
It was 5:27 p.m. on a Friday evening when the pager went off. “Ahh,” said the intern, “Three minutes before shift change, and the ER is paging for another admission!”
I could see the dismay on his face as he dreaded the thought of staying late on yet another Friday night. I decided to take care of this patient myself and relieved the intern of his duties. As I went downstairs …
The pay gap between men and women has been a subject of interest recently, particularly in 2018 reports by Doximity and Medscape.
Notably, the gap favors men, is not explained by obvious factors such as hours worked or choice of specialty, and does not seem to be improving. In-depth studies published in the medical literature have examined the relationship between gender …
The antiquated conversations on the gender pay gap
“I give up! I can’t help these people.” Emily was completing the final month of her emergency medicine residency and flopped into her chair with exasperation.
“What’s up?” I asked. We were on the final two hours of our shift together. And I, as her attending, was already feeling apprehensive about the patient encounter that awaited me.
“They want so much from me, and I can’t fix them!” She began to tell …
Sometimes what patients really need can be surprising
Fourteen hours into their shift, the intern headed down to the lobby to pick up the delivery. Today it was Indian food. He struggled to push the elevator button while holding the bags but managed to make it up to the top floor ICU. The rest of the surgeons gathered around the table cluttered with spent pens, journal articles and unused bottles of lidocaine to eat. Someone offered up their …
Imagine spending days or even weeks in an emergency room without treatment for a broken leg or painful kidney stone.
Patients in psychological crisis across the country are living this exact scenario. Long waits in an ER, hospital room or prison for an inpatient psychiatric bed, otherwise known as psychiatric boarding, are their unfortunate reality.
Rewind to over 50 years ago — as institutionalized patients were gradually integrated into communities, the availability …
Let’s talk about the psychiatric boarding crisis
Have you ever been the only customer in your local supermarket? Although the experience can be a bit unnerving, at first, you soon start to notice the advantages: No line at the deli, no pushy shoppers, no carts jamming up the produce section. As you breeze through checkout, you think to yourself, “Gee, I could get used to this.”
Now, imagine walking into an empty waiting area at your local emergency …
3 ways to decrease emergency department wait times
Since the beginning of the fourth year of medical school, I have lived in six different cities and have been fortunate to call a Michigan apple orchard, an island on the Mississippi River, and a little apartment in the Coolidge Corner neighborhood of Boston home. I come to you as an emergency medicine intern fully immersed in the second month of residency excited about what the future holds as a …
How to separate good medical students from superb ones
What is it?
Kratom is a powdered herbal supplement derived from the leaves of a tropical evergreen tree that is native to Southeast Asia and is usually taken orally but can also be brewed into teas.
It is commonly used by consumers as an alternative medicine to self-treat opioid addiction and chronic pain. The leaves contain two compounds, mitragynine and 7-a-hydroxymitragyine, which interact with various receptors in the brain.
At low doses the …
Kratom: harmless herbal supplement or dangerous drug?
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There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland.
But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 …
The many ways to describe chest pain
Doctor: (from Latin docere “teach” Greek phusikḗ epistḗmē “knowledge of nature”) a specially trained and skilled person who holds an advanced medical degree and is licensed to practice the healing arts.
My definition of doctor keeps evolving. As a child, I was cared for by FPs who helped set bones, suture skin and fight infections like measles, chicken pox, and strep. Though I didn’t like going, I usually experienced healing on …
The evolving definition of doctor
“If there is a physician on the plane, please press your call light!”
The vast majority of doctors who have flown on airplanes have heard this, and most of us are willing, if not entirely eager, to respond. What follows is usually a far from ideal encounter with inadequate information, too much noise, a cramped space to work in and little knowledge of what is expected or even possible.
My experiences (I …
How to improve the care of in-flight emergencies
As I prepare to go into work for another string of night shifts, I become aware that this is just another holiday that I will be working. It’s the Fourth of July, not a major holiday as is designated by any scheduler, so no credit will be given to those of us who work today. Some previous employers have given extra pay for said days, as little as $200 to …
I can vividly remember my first day as a real doctor. I started on the pediatric pulmonology service, and recall spending what felt like an hour, deliberating whether I could order Tylenol for my patient. Would it interact with the Pulmozyme treatment? Fortunately, I had very patient senior resident who calmed my nerves and was empathetic to my intern anxiety. Summer is an exciting, terrifying, rewarding and sometimes frustrating season, …
What is your blindspot: managing cognitive bias
I come by many things in my life naturally — my stubbornness, my red hair, and my career. I am very fortunate. Unlike many I am the daughter of a female emergency physician. This is something I never really considered while growing up. Yes, my mom was a doctor. Did she save lives? I guess so. She didn’t spend much time talking about life outside of the home, and she …
Growing up with women in emergency medicine
Yesterday, I had an eye-opening experience that made me reflect once again about relationships.
During the afternoon, I had to attend a mandatory trauma simulation event. Since I am a surgeon, I am referring to physical traumas like traffic or firearms accidents, and just to be clear — psychological traumas are not included in these groups, even when I firmly believe that some of them would justify such an efficient and …
Medical simulation as a moment to reflect
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