I am three weeks into my summer break and I have been a lot busier than I ever anticipated. I am hoping things will slow down a bit for the next couple of weeks so I can just enjoy some down time.
I spent one day a couple of weeks ago shadowing an ER attending physician. This was a summer program set up by a student interest group. (The ubiquitous SIG – there is one on campus for every area of medicine!) I am not really inclined toward ER stuff as a career right now, but I did want the experience of seeing what it was like. It was a Wednesday, so the usual weekend gun and knife club members were not in view. The most dramatic patient was a construction worker who had his leg run over by a bulldozer. He was a flagman who sat down to drink a soda and apparently wasn’t paying attention. It was not terribly gruesome but he definitely needed orthopedic attention. I had to help roll him over. He probably weighed in at close to 300 pounds and was screaming in paid during his entire ER stay. Thankfully he was moved to surgery pretty quickly.
Another man was brought in with a sudden deterioration of mental status. He was 42 but looked 62. He had a history of seizures, alcoholism, and cancer to start with. He was running a 105 degree temperature and was incoherent. I got to assist an intern with a lumbar puncture to rule out meningitis. It was the first time I had seen one done, and it was cool to see the clear CSF draining from the needle and realizing it was in the dura of the spinal cord. The ugly politics of a charity hospital came into play on this guy. Nobody seemed to want him. ER had him stabilized and he obviously needed to be hospitalized. The internal guys wanted to shovel him off to neurology but they did not want a possible infectious disease patient. He was still taking up a room in the ER when I left 6 hours after he had arrived.
Many of the other cases were routine but disturbing. Patients complaining of back pain looking for prescriptions. A Mexican woman who had been in an automobile accident 18 months earlier and who was in chronic pain but could no longer afford the private doctors she had been seeing. She spoke no English and a social worker came in to translate because none of the residents or nurses on staff could speak Spanish. Growing up in El Paso, Texas, I had some Spanish education up through sixth grade but have lost it all now. However this incident has really made me think about trying to pick it up again. There is a growing population of Spanish speaker here in Mississippi working in the chicken processing plants and looking for temporary work.
There was a middle-aged woman who came in with a list of vague complaints. She had just been released from another hospital after a seven-day stay for similarly murky reasons. She came with her bags packed ready to be admitted, but wanted no part of a psychiatric admission. In fact between her discharge from the other hospital and her arrival at UMC she saw her psychiatrist who gave her a statement to bring in declaring her emotionally and mentally stable. She was accompanied by a “dear friend,” who antagonized the staff, demanded treatment for her friend, and informed us several times that this lady’s late father had been a doctor. Her chief complaint was “weakness” but in trying to get more details she just rambled, complaining about everything from allergies to her suspicion that she needed both knees replaced. The attending was hoping the blood work would come back showing anemia or something he could admit her for. Each time he got ready to enter her examining room I could see him gathering his patience to face her.
I was struck by the way this all becomes routine for the staff. They have seen it all, and cannot help but become inured to it. When one young woman came in and demanded a tray of food before she had seen a doctor, she was told, “this is a hospital, not a cafeteria.” The attitude you’ve got to have is even reflected on the dry-erase board that charts all of the current patients. As I looked it over I recognized most of the standard acronyms; SOB – shortness of breath, CP – chest pain, etc. I had to ask about one of them though – AAW. The attending told me that this person had endured an acute ass whupping. Ahh, emergency room medicine – you’ve got to love it.