Emergency physicians, nurses, and residents writing on KevinMD from the emergency department: acute care, the realities of the ER, boarding and overcrowding, violence against staff, and medicine practiced under pressure. Most contributors work in emergency departments. For what emergency physicians and nurses have said about being assaulted at work and told it was part of the job, see Violence against health care workers: what physicians and nurses say, in their own words. For what emergency physicians wrote in the first weeks and months of the pandemic, see COVID-19: what physicians wrote as it happened. For what emergency physicians and pain patients have said about opioid prescribing, see Opioids: what physicians and pain patients say, in their own words. For what physicians in the highest-burnout specialty have said about burnout since 2009, see Physician burnout: what physicians say, in their own words.
Recently, my friend had a patient. The guy, patient with a history of autoimmune disease came in with pain, anxiety, and tachycardia. She walked in and felt the psychosomatic overlay. What was her intervention? Meds? Psych? Nope.
She closed the door, held his hand, pulled out her mom self and let him tell her for 15 long minutes about his hard life. The nurse watched the monitor as his heart rate dropped in …
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Can we say that women doctors are just better for everyone?
“Well? Did you save him?” “No. We did better than that.”
He came in pulseless. The machine performing chest compressions with the rhythmic thud, thwack, thump. His ribs heaving under the force of the compressor, keeping his heart artificially beating. The plastic tube secured in his airway forcing puffs of air to inflate his lungs. His skin slightly purple-gray, on that narrow brink between life and death. His eyes like speckled …
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We didn’t save his life. We did better than that.
I hugged them longer than any 10- or 11-year-old wants to be hugged by their mom, and tried not to cry tears of gratitude that they were in my arms. The last kid their age I saw was the one I had resuscitated and admitted to the PICU just hours before, and it took my breath away to think about that happening to my sons. I had to make one …
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Why this emergency physician is thankful this holiday season
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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An emergency physician’s brush with death
Buprenorphine was a fantastic drug in the emergency department. Patients would come to our ED feeling awful from opiate withdrawal, and we made them feel so much better. We can recall so many patients coming in vomiting, anxious, sweaty, dehydrated, and looking awful — and with one or two shots of buprenorphine, we made them feel well enough to take on the task of beating opiate addiction. A clinic in …
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Buprenorphine: One way works. One doesn’t.
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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Time is fleeting and doctors must focus on what’s important
Every day, millions of women across the United States find themselves in predicaments confronting the quality of their appearance. And their makeup. While this may seem a non-issue in the emergency medicine world, it is something that you, as a female professional, or that your female colleagues, have no doubt encountered. Before walking out the door, you have to consider not just what means of transport to take to …
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Makeup and the female physician
A few weeks ago, my employer sent me to a three-day out of town conference. I had mixed emotions. It would put a burden on me to work more than usual both before and after it, but I couldn’t help but look forward to the blissful, uninterrupted sleep I would get in a cozy, quiet hotel room. There was guilt when I realized that my wife would shoulder the full …
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Handheld electronic devices are the thieves of our meaningful moments
I was at work a few nights ago. We had had a patient death early in the morning before I got there, and the body was still in the room awaiting the JP’s arrival. The family was en route back with the children (he was only 57) and the body was not presentable. Blood, saliva, a gaping mouth and lividity with rigor were a bad combination for the kids to see. …
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Pretending the world is homogeneous is a dangerous path
I had never heard the term “throughput” before a meeting at our hospital two years ago. It was used to discuss how the emergency department (ED) could yield greater profits by faster patient turnover. Coordinating various duties (including intake, admitting, and cleaning staff; lab and radiology; nurses and doctors) patients could be shuttled into and out of the ED earning the hospital $2 million more per year.
This strategy was implemented …
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Patients are not fast food. Stop treating them that way.
A few months before election day, a grassroots group was created on Facebook called Pantsuit Nation. As the name probably implies, it was a group for Clinton supporters, where we shared our positivity about Hillary Clinton as a candidate and offered endless empowering stories about why we were voting for her. The group was secret, but as its numbers swelled to over 3,000,000, it was hard to keep …
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What this physician learned from Pantsuit Nation
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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A frazzled doctor finally learns how to relax
As she lay on the gurney telling me she was tired and having vaginal bleeding yet again, I was doing my own biopsy of her medical record.
It stated very clearly that palliative care and hospice had been recommended to her for her end-stage gynecologic cancer. So, why, I’m thinking, highly annoyed, is she now in the ER, late at night, creating problems for me? Why could she just not accept …
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A physician’s compassion well has run dry
Recently I’ve seen a number of reports of women who are denied the ability to help in a plane emergency because they are not believed to be doctors. While most of the denied women are of color, since this became public a large number of women of all races have come forward because of similar racial and gender discrimination.
I am an emergency physician, and I was once called to duty …
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Flying the deadly skies
Four years ago, I was having a conversation with a friend of mine. We had graduated residency the same year and our careers had taken us to different parts of the country. It was ACEP 2012. We’d been mingling with old friends and current colleagues, and the conversation turned to kids.
I told him my wife and I were getting ready to start having children. He said he and his wife …
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Physicians need to take a broader approach in their first job search
“Good morning, Sandy. How was work?”
How do I answer that in a normal way? Any given shift in any given ED is comprised of the gamut of emotions playing out behind the calm facade of physicians and nurses. Afterward, we often don’t articulate or even process the roller coaster of feelings. The story of a recent Monday overnight illustrates the wild ride of emotions most people don’t realize that emergency …
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This was my night in the ER. How was yours?
One very late spring evening during my last year of residency, I was driving home and got stopped at a police DUI checkpoint. I was exhausted from being up all night from being on call the night before and having been very busy had no time to shower, shave or change into my street clothes. I also got called in at 4 a.m. the previous day and had not showered or shaved that …
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The night this physician was profiled. And he was OK with it.
You have to create a disconnect from death. Not indifference, in fact, it’s your duty to combat it. But as an emergency medicine physician, you lose that battle often. I encounter death on a near daily basis as a resident in the emergency department, and despite all my years of training, there’s often nothing I or anyone can do to prevent it. Health care workers in such an environment often …
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When physicians can’t hide the emotion
I am sharing this account of a serious medical emergency on a transoceanic flight because I hope it helps other health care providers assist people in the future and learn from the difficulties I encountered.
About 8 1/2 hours into a 17-hour flight, a gentleman had a syncopal episode in the exit row I was sitting in. His face was bleeding, and he was having issues controlling his bowels afterwards. His …
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Syncope at 35,000 feet: A physician’s harrowing story
