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Christmas Eve in the ER

As my thirteen year old daughter would put it,  “it bites” being stuck working on Christmas Eve in the Emergency Department.  Considering how busy we normally are on a typical work day, the fact that I am able to sit here with the nurses at the computer typing this entry I find thoroughly amazing.   Since 2:00 pm today, my staff and I have been keeping a tally of what pathology has shown up so far.  The tally is as follows:

1 ) Varicose vein that bleed and stopped bleeding  before arrival.   Bandaid applied

2 )Elderly lady.  Syncope in the closet.   Etiology unclear.  Admitted

3 ) The diabetic husband of the elderly lady who fell into the closet (see #2 above)  felt his blood sugar was low while trying to pick his wife up out of the closet.  Sandwhich provided.  Discharged

4 ) A nonbleeding, nonthrombosed hemorrhoid.  Tucks Medicated pads suggested. Discharged

5 ) A chronic alcoholic who was brought in because feeling short of breath for days.  Medics described new onset afib.  Turned out to be an MI who had already “Qed” out inferiorly.  Transfered to facilitiy with cath lab.

6 ) Cardiac Arrest in a cardiac transplant patient.  (Horrible!   Trying to be nice, we shut off all the Christmas music until family left)

7 ) toothache

8 ) Back sprain after a motor vehicle accident

9 ) A scrotal bleed (Don’t ask.  Really.   Just don’t)

10) Intoxicated alcoholic

11) A panic attack

12) A violent patient with dementia arguing with my 5 foot ED colleague.   Demented patient won!  (Staff taking bets at nursing station whether five foot tall doctor would win.  Not so much. )

13) An ankle sprain.

14) Another toothache.

15) Another minor MVA

16) “I’m out of town and I am out of my oxycodone, percocet 15, ambien, and lorazepam”    Discharged unhappy

17) Packing removed from a recent I&D of an abscess

18) STD check (really? On Christmas Eve?   Yep .  You have one! Discharged.  Really.  Pun intended. )

19 -22) Assorted lacerations.

23) Knee sprain from three days at work. ( Just ask for the work note!  You told us you were do in and we saw you walk into the ER without a problem. )

24) Shingles out of meds.

25) Another alcoholic psych patient.  Every racial slur .  Where is my five foot physician colleague?  This has his name all over it.

26) MVA  – refusing evaluation.  Brought in by BLS

27)  Chronic back pain – seen recently.   PMD won’t treat pain.  “Nobody understands me”

28)  Another drunk. “I want to go to Kosovo so I can fight for my country….I want to be a hero…..I don’t know where Kosovo is….do you know?”   Patient can barely stand up straight let alone be trusted with a rifle.

Thus, in an Emergency Department which has a volume usual of 120 patients or more a day, since 2:00 pm today, that is our total census.  Of this census, 5 via ambulance  total.

I dare say that after the salt ladened ham, seven fishes, alcohol, and over eating, none of us will be able to make a similar entry tomorrow.

Merry Christmas to everyone from my staff and colleagues at the Emergency Department!

ADDENDUM:   The above represented the time window from 2pm to approximately 8pm.    The ER exploded at about 9pm.  There were probably more police with people in custody in the ED that night than were manning the local stations.  The psych unit exploded.

As I head in to work now, I expect no different.  The doctor’s offices have been closed, those that should have been in yesterday probably have delayed to the point that they can’t hold out much longer, and, of course, the usual weekend crowd.

Posted in ems-topics, patient-management, Uncategorized

No comments Posted by on December 24, 2010

The Free Taxi Ride

Years ago I was working with New York City as an EMT out of Queens General Hospital.  I remember being in shock after picking up an otherwise non-ill appearing man who gave a complaint that I currently cannot recall.  We took him in a city ambulance to the local hospital.  The part that shocked me was that he never entered the hospital.  He thanked us and proceeded to go across the street to do his shopping. He never was sick and never intended to enter the ED doors.   We served as free transportation for him.   He expressed no qualms regarding his actions.  The only conclusion I can draw today was that, in his eyes, it cost him nothing.   He was able to get away with it.   He had a complete disconnect not only from the ethical issues of what he did, but the costs being eaten by the city government for the taxi ride.

The same issues apply daily in the care I provide in the Emergency Department.   There are multiples of patients who use the ED as primary care who are donning the latest Iphones, wearing expensive leather jackets, downed in expensive Aeropostel and Uggs clothing.  They are at a lost when I ask them who provides their primary care.  “I just go to the hospital!” Attempts to explain to these people the importance of routine primary care by an appropriately trained individual falls on deaf ears.  They will openly admit that the use of clinics and primary care facilities will cost them money.  They have nothing in the game.  Hence, using one of the most expensive forms of medical care, which often isn’t the best care, continues to be used and abused.

I recently questioned an administrator regarding the potential logic of opening up various clinics.   Perhaps a pediatric clinic on Tuesdays staffed with board certified pediatricians, Wednesday an adult primary care clinic staffed by Internists, and so on.  It seemed like a perfect solution to me to guarantee good follow up with individuals most appropriately trained to assure convalescence and preventive care.  “We looked into this, and financially it isn’t viable.”  In other words, my translation of this statement is that the hospitals can collect more state money for emergent care for non emergent patients than they would receive if they set up and established local clinic care.  Follow the dollar signs.   The current government bureaucracy continues to do a disservice to the very individuals they are supposed to protect.

Emergency care being a safety net and providing primary care is something that will never end.  However, I wonder how much general abuse would stop if the general public had to send in their taxes monthly rather than not realize that they are disappearing from their paychecks until April 15th.  In other words, each month a payment would have to be sent in no differently than a payment to a cell phone carrier.  The statement of “let the government do it” would be reconnected to the concept that the government is us.  Abuse local services? – Your taxes go up.   Your monthly payment to the local government-taxing agent goes up.   Don’t pay?  Sorry – your garbage will no longer be collected.  Don’t pay?  Sorry, your mail service stops.

Will this ever happen.  Of course not.  Still, free taxi rides are destroying the system.

Posted in 911, ems-health-safety, ems-topics, healthcare reform, patient-management

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10 comments Posted by on December 22, 2010