Nurse K’s post on “ER Rushes” gave me an idea to do my own version of a typical weekday.
0600-0800: Just when the staff are changing shift (and honestly, the out going shift really does NOT want to see any more patients!) come the sickest people of the day. MI’s, Massive GI bleeds, Acute Strokes, and overwhelming sepsis from the nursing home. Mixed in are a few suture removals.
0801-0930: “Slow”time. Amazingly, this always seems to be the slowest time during the day shift. Sometimes we actually sit, eat a bagel, and shoot the breeze.
0931-1200: La Fusillade de la Clinica. All the patients who are turned away from our clinic start pouring in. Usually they are either. A. Pregnant women not yet registered for the clinic who have bleeding or cramping, B. Children with the sniffles who were turned away because “They were too busy”, or C. Complaining of a problem that is both non-urgent and has been going on for months to years.
1200-1600: Doctor’s offices messes. People showing up at their MD’s offices with problems that were either too urgent, complicated, or annoying for the MD’s to deal with. They are put on an ambulance and shipped over. Frequently there are some sickies in here – mixed in with the social dispos.
1601-1700: People rushing to make it in by 5pm so they can “meet their doctor” in the ER. Of course their doc had been there 2 hours prior waiting for them but has now left. By the time they are brought into the department, the on call doc is covering and knows ziltch about the patient.
1701-2100: Fractures, lacs, and head trauma. All the out of shape middle age men, overly ambitious children, and corporate Moms rush out to enjoy the outdoors. They fall down, crash their bikes, twist ankles, blow out knees, and ram into sharp edges. Fast Track is jumpin’.
2101-2400: Upper and Lower GI fulmination, abdominal pain, and chest pain. The post dinner rush. Those who ate too much, shouldn’t have eaten dinner at all (because they have been having pain all day), or got into post prandial family argument arrive with the sluices open at both ends, writing in pain, or ruling in for MI.
0001 – 0300: The drunks cometh. Usually found on the street or passed out in a bar somewhere, the ETOHers arrive with a flurry or excitement. Either cursing at EMS and being restrained by the police, or lying there with a respiratory rate of 5, we either rush over to give them Haldol and Ativan or to do a good sternal rub just to make sure they are still alive. They are mixed in with some suicidal patients who want to be admitted to the psych floor but have to wait til the morning for the psychiatrist to return. They also get Haldol and Ativan too.
0301-0559: Complete Nonsense. This is the time that all the utter nonsense comes in. Simple rashes, kids with a fever for one hour, vague generalised weakness and dizziness, and prescription renewal/narcotic seeking chronic pain patients. Their arrival prevents the doc from getting any sleep.
I love your site. Back in medical school Emergency Med was my original specialty choice and my 4th year electives include 4 weeks of ER at my med school, 4 weeks of ER at another med school, 4 week of PEDS ER and 4 weeks of Emergency Psych. That’s before I made the change to OB and later to REI. I still miss the excitement of the ER at times. My typical day seems so tame by comparison. I thank you for the chance to live vicariously through your wonderful blog!
Utter nonsense time is the best time of the night! Last night’s notable chief complaint at 5:15 am was a young man with “poison ivy” with no identifiable rash and 10/10 pain from the “rash” that wasn’t there. What the Hell? Later, it was a chick who had pleurisy and wanted “droperidol” for it to “relax the lung muscles”. Also, I wrote in “stomach twitching” the same night. Not the stomach muscles, no, the stomach itself was twitching. Or something.
How true! This totally mirrors my night experience in the ED. And like IVF-MD said, utter nonsense time IS the best time. Especially when you have the “excruciating” abdominal pain eating Big Mac with soda in the waiting room.
Utter Nonsense? How appallling for you to describe your job as if it is a drive thru! You should be ashamed of yourself and should be banned from the health care industry – is a matter of fact I will find out who you are – where your from- and submitt this blog to the appropriate people who issue your liscense in the first place – these are “people” who look to you for care – not sarcasm disconcern for your what you do – godforbid you ever need er care – Your pathethic in the lowest form – get another job! Oh yeah if you can handle it!
“Either cursing at EMS and being restrained by the police, or lying there with a respiratory rate of 5…”
Haha!! I think none of my own ER stories are as entertaining as the ones involving the ETOHers. I had one woman with a blood alcohol limit of 5 times Texas’ legal limit swear to me (once she extubated herself and finally sobered up somewhat) that she only had “one glass of wine” and that somebody “injected her with alcohol.” The real kicker was when she told me to please ignore the cases of wine she had in the backseat of her car — the one she was driving when she was found wrapped around a tree yet, amazingly, without a scratch on her body. (She had been intubated because of her violent behavior.)
If you only work 30 some hours a week, as you said in one of your other posts, why do you need to sleep while you are there? Quit bellyaching, you chose this profession, deal with it, or find something else to do.
It doesn’t matter how many hours you work – when you work an overnight (or at least when I work an overnight) and hour or two of sleep makes all the difference in being at a high level of funciton. I accept my overnights but that does not mean I have to like them. I am sure Mike that you bellyache about some aspects of your job.