The ER is a place seemingly designed
for Hollywood-level drama. It's a big room full of people suffering the
after-effects of tragic accidents or the sudden onset of vicious illnesses.
You've got mourning families, bullet
wounds, people shouting STAT and waving electric paddles.
But what
about the men and women who call the ER, well, not home,
but at least "the office"?
We wanted to know what television
leaves out, so we sat down with an ER doctor for a candid look behind the blue,
plastic, blood-spattered curtain. She told us ...
#5.
Doctors Train on Your Body
Once, I was showing a new family-medicine doctor how to do
his very first spinal tap -- a procedure in which a long, thin needle is jammed in between two
vertebrae in the lower back.
I started by having him watch a video of someone else doing
it. On YouTube.
So, he watches the YouTube video
outside the room, and I remind him that if he felt resistance as he was pushing
the needle in, that was probably bone, and he'd need to withdraw and try again.
So, he starts on the patient (who is
awake, but out of it) and pushes in hard. He keeps pushing, and finally says,
"I don't think I got it in the right place."
So I go to pull the needle out of
the patient's spine, and I can't. The needle's stuck in there.
When we finally got it twisted out
of the patient's spinal column, we saw the damn needle was bent at a 45-degree
angle because he'd slammed it into the bone so hard.
The patient never knew (drugs erase
all mistakes and bleach every sin).
"Why
was he practicing on a live human being?" you might reasonably ask.
The answer is that there is no
perfect analog for a live patient, and somebody had to be his first.
That's why we have teaching
hospitals: you can't learn everything with dummies and simulations.
We're all OK with this in theory,
but in practice it means at some
point you'll be at
the hospital and someone will be training on
you.
It might be a nurse doing an IV, a physical therapist getting
you out of bed, or it might be your doctor.
In the good old days, medical students got more of this
hands-on training before they graduated, but due to changes in medical
education, brand-new doctors often have to learn on the job.
As a senior resident, I've walked interns through everything
from a pelvic exam to a lumbar puncture to a central line placement (that last
one might not sound too bad, until you realize a "central line" is a
large IV usually inserted directly into your jugular).
Unless the patient asks, I never volunteer the fact that
someone hasn't done a procedure before -- it just adds a level of stress for
the patient and the doctor that neither party needs.
Instead we play it cool, trying to project an aura of
confidence like the intern didn't just look this up on YouTube a few minutes
before entering the room.
And I guess here I should address the obvious question ...
#4. I Also Google Your Illness
#4. I Also Google Your Illness
People expect doctors to know everything.
We go to school for years more than most people, we seem to
make a ton of money, and a lot of us have nerdy-looking glasses.
So it would make sense that we are bottomless wells of
knowledge, and shows like House and Grey's
Anatomy don't do anything to dispel that
notion.
In the real world, if a patient
shows up to the ER with a somewhat rare disease, instead of immediately knowing
the nuances of the pathophysiology, epidemiology, and treatment, I'm struggling
to remember the basic details of a disease that I learned about back in medical
school.
There are just so many things that
can go wrong with the human body, and no doctor has the capacity to remember
every single one of them.
There's a reason we keep all
those giant, impressive books in our offices.
And Google,
well, it's just a book that works instantly, and occasionally directs you to
porn when you're trying to study up on genital warts.
And even if whatever rare sickness
you've contracted is something
I've studied before, it might have been years -- if ever -- since I've had to
actually treat it.
Goodpasture syndrome ... is that the kidneys? The lungs? The
... hooves? Is it treated with steroids or do steroids make it want to kill you
more?
In pseudopseudohypoparathyroidism, is your calcium too high
or too low?
These are not things that I see
every day, or even every month, so I need to refresh myself on them when a
patient turns up with one of them.
I'll get your history, do a
physical, and then hurry out to Google your disease before I talk to you again.
#3.
We Have to Find Time to Relax While Other People Are Dying
Patients (and their families) don't like to see doctors relaxing at the hospital.
I understand that -- if your husband is having a heart
attack, you don't want to see me laughing with my colleagues about the crazy ending
of The
Walking Dead the other night ("I cheered when
Daryl smashed that zombie's head in the car door!").
Or if I just put a breathing tube down your mother's throat
because she had a massive stroke, you really don't want to see me sitting at my
computer a minute later, eating gummy bears and texting my boyfriend about
what's for dinner.
On an intellectual level, you know doctors lead normal lives
outside of the ER.
But on an emotional level your loved one is sick and I'm blithely popping candy in the next room like some
sort of sociopath.
But this is my everyday
life, my job.
How many of you go a 12-hour shift
at work without any sort of break?
Doctors need downtime too.
For most people, a trip to the ER is
a scary, very rare occurrence.
For me, it's 60 to 70 hours a week,
every week.
Once we've diagnosed a heart attack
and started treatment, there's not a lot more for me to do if the patient is
relatively stable.
If you see me chatting, it's because
I'm waiting for a blood test to come back, for the cardiac specialist to call
me back, or for the pharmacy to deliver medications.
It's not
because I don't care or because your loved one's suffering isn't important to
me.
It's because I wouldn't be able to
survive in this job if I couldn't compartmentalize.
On a bad day, I've had to go from an
hour-long code on a young girl who died in the trauma bay after being hit by a
drunk driver, immediately into the room of someone looking for a prescription
for pain medication.
I have to show compassion to that
person, with the echoes of that little girl's dead eyes in the back of my mind.
#2. We Notice Some Weird (Cynical)
Trends
Mondays are the worst.
About 5
percent of what I see in the Emergency Room are actual emergencies, 10 percent
are urgent cases, and the rest of the people who come into an ER could probably
have waited for a normal duty doctor.
And a huge number of those
non-emergency, non-urgent cases flood us on Monday.
Why? Well, if someone pulls their
back on a Friday, they're not going to waste weekend time in the hospital.
They're going to come in Monday --
to get their minor injury seen to and a doctor's excuse for their work absence.
There are a
lot of things like that we start to notice over time.
Another one: the patients most
likely to pass out while getting stitches are young guys with tattoos -- women
and old people do so much better.
I make the young guys lie down
before we even start. They're going to pass out anyway, and anticipating that
makes less work for me.
And then there are the drug-seeking people;
They're not usually hard to spot.
They'll claim, "I'm allergic to everything but one drug
... it starts with a D?" That's the narcotic painkiller Dilaudid, and they
damn well know the real name.
But every drug-seeker seems to follow the same script:
they'll come in claiming some legitimate, recurring problem, and then act as if
the name of the only pain drug that works for them (which just happens to be a
narcotic, every time) is some half-remembered riddle.
If this all sounds like I'm being judgmental, well ...
#1. Yes, I'm Judging You
I said above that only a small
percentage of what I see are actually urgent cases.
Well, everything about the whole ER
experience -- from the long wait to the annoyed look on a nurse's face -- makes
more sense if you keep that in mind.
As for me,
it takes only a few minutes to know if I like you or not.
It's not going to affect your
standard of care, because I'm a professional. But it might affect if I
remember to tell your nurse you asked for a blanket, or if I go out of my way
to offer you a written work excuse. Petty? Maybe.
But this is what you're going to get
until they finally staff hospitals with robots: ER doctors are human beings and compassion fatigue is an actual thing.
Once you see enough gunshot wounds
and car wreck victims, it gets difficult to care about someone who declares
their chronic back pain to be an emergency.
If you think it's callous to be annoyed by someone who is
truly in pain, you have to keep the context in mind.
Everyone who walks in thinks their situation is an emergency
-- it's right there on the sign -- but only some of those people are right.
And there is no correlation between how much people
complain/make demands and how urgently they need help.
The person screaming for pain pills for their pulled muscle
is going to have to wait behind the guy who is quietly hemorrhaging.
And the person who has to wait is not going to like it.
Things that will earn my wrath: boasting that you have a "high pain tolerance" (if you've had that thought, it's almost certainly not true), not having any idea what medications you take, not having tried anything for your pain at home (you are young and healthy, it's OK to take a Tylenol for your toothache before coming into the ER), being above the age of 10 and bringing a stuffed animal in with you, the list goes on.
Doctors are human, and we definitely
do not have an endless amount of patience.
And nothing in medical school taught
me how to be forgiving of someone who, for instance, claims they couldn't
afford the antibiotics that were prescribed for their child, but show up with
cigarettes in hand.
If you're
worried about pissing off your ER doc, remember: it's not hard to avoid.
Just be honest about your symptoms,
and don't be offended if we aren't always as sympathetic as you'd like.
You have no idea what we saw 10
minutes before walking into your exam room.
Source: http://goo.gl/YbQg77
#midastouch
