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.


  1. No,there has to be some other explination! I won’t go to the ER, there is nothing they can do for me!
    Your heart is racing, I can’t count your heart rate it’s so fast, the doctor asked if you got feeling like this again to PLEASE go to the ER …
    Why? there isn’t anything they can do …
    Your blood pressure is 82/50 AND your heart is racing … would you PLEASE go, at least they can give you fluids to help.

    They don’t worry about low blood pressure.
    (mine however, was rising to degrees previously unknown to my body)

    next day at the doctor .. ekg showed he was in Afib ..would he go to the hospital …no …there was nothing they could do for him. (ARGH!!!!!!!!!!!!!!!!!)

    Thankfully, it was a medication that caused the Afib and a few days of feeling like crapola he went back into sinus rhythm and was ok …

    Wouldn’t you have LOVED to have been the ER doctor to try to explain to him he wasn’t ok if I had talked him into going?

    *crossing eyes*

  2. I love those kind of days. They make all of the other non-sense days seem almost worthwhile!

  3. I was one of those patients the other day. Heart probs. Admitted for observation.

    I will be paying the hospital stay off until I die. :(

  4. hahaha,”I have my own merck manual” haha. Another one of those could be “I watch Grey’s Anatomy! I know what to do!” My sister actually said that to me the other day… that she knew all about intubating because there was an “ER” episode about it.

  5. When other specialists talk down to me, I look at days like this and smile proudly in their faces. Don’t know too many other specialties that would feel comfortable managing such a variety of cases.

  6. “Don’t know too many other specialties that would feel comfortable managing such a variety of cases.”
    Everyone has their own perspective. Should someone’s be a little skewed, I think it’s simply good human nature to show a little patience…but it’s okay to do so while thinking (not saying), “You would curl up into the fetal position under the charge nurse’s chair if you had to spend one hour here”. Kinda like the rich kid finding themself in the dirty alley. They’re scared, overwhelmed…they just need a friend to help them with what they need and shown the door.

    Oh, it would be nice to flick one of those obsessive House M.D. fans on the nose. I always wonder why they’re in the ED if they already know what’s wrong with them and know they’re safe to go home and will get better after a few hot totties and some rest?