A day of Emergency Medicine?

Today was the first day back to work after a four day holiday. The patient acuity was high, which was a nice change:

  • The Septic Senior, with a-fib at 200, a systolic of 70, on digoxin and coumadin,
  • the Trauma Transfer, with the as-billed bleeding liver lac and free abdominal air, but also including the the undisclosed spleen lac,
  • the Arrest in the Ambulance Bay, who died despite all our efforts,
  • the Killer Back Pain, with the Type B aortic dissection,
  • the Altered Mental Status, with some dehydration and a seizure disorder on the side…

And those were in the first two hours. I really believe that some people ‘hang in there’ through the holidays, and then pay the piper for the privilege.

And, those who are sent to remind us to be humble, and maybe a little miserable.  The patient who, when presented with their diagnosis (really, irrefutable given the history and testing), says

  • “I don’t agree”.
  • me: Yes, it is. That’s what all the tests are for.
  • pt: “No. I have an Uncle who was a doctor, and I have my own Merck Manual, and I don’t think that’s right.”
  • me: Ummmm, okay …

All in all, a good day to be an Emergency Physician.