Friday, September 21, 2007

It Begins

Well, here goes the start to another weekend. Swing shifts this time, not nights like last weekend. But I'm sure the parade of fools will be similar, just more awake and a little less intoxicated. Here is a sampling of last weekend, in no particular order. Oh, there were a few emergency cases, and a code, but they were nearly drowned out by:

1. The 17 year old by ambulance with pharyngitis.

2. The one year old just not able to sleep with cough and fever, already seen by their pediatrician earlier that day.

3. The 20 year old G7 with belly pain who left AMA after learning her pregnancy test was negative.

4. The dialysis patient who was "too sick" to go to dialysis and presented in acute pulmonary edema.

5. The 40 year old female covered in paint and drywall, obviously working, who presented with severe back pain from an MVA 3 weeks prior.

6. The 73 year old who just can't catch his breath after smoking 2 packs per day for 50 years.

7. And the dozen or so patients who just want a fix (narcs, benzos, it doesn't matter).

So you see, it's easy for me to get fired up for 3 day weekends in the ED. Stamping out disease with clown shoes, one idiot at a time.



  1. I agree. Granted, I'm just a mere resident in EM, but I did my overnights last week, and we had:

    6 yo male complaining of "wet farts for 6 hours"

    21 year old "drunk and passed out in the car"

    38 yo female with 17 abdominal operations complaining of "I think i need another operation....i may have a small bowel obstruction"


  2. Last weekend, my "favorite" case was the mother who brought the 3 day old in by EMS because the baby's "hands felt cold".

    Fortunately, EMS delivered the curing treatment of a blanket en route and by the time they arrived at 4am, the baby was perfectly fine.

    I'd have been somewhat assuaged in my irritation if it was the woman's first child, but sadly it was the 23 year old's 5th kid.

  3. ...sadly it was the 23 year old's 5th kid.

    Well, with that many kids, you know she or her husband must have a good job and must be otherwise productive members of society. I mean, that's 5 college educations they'll have to pay for already.

    I'm sure her insurance company will question the necessity of her child's ambulance ride, but with her timely payment of insurance premiums and otherwise prudent use of healthcare services, she shall surely be forgiven.

  4. Yes, fortunately this woman who spoke little English (so we had to pay our interpreter to get out of bed and come into the ED at 4am) was covered by the universal New Orleans New England (NONE) plan. The NONE company is always prompt and never questions the need for an ED visit!

  5. How about the teenage parents of a three-day-old who brought their baby in, saying, "she has diarrhea" (uh, that's normal breast-fed baby poop) and "she sleeps all the time" (uh, that's what new babies pretty much do)!arg

  6. A quick question for all the ER docs reading this blog. As a first year med student, ER is currently (and it changes often, obviously) one of my top career interests. But honestly, reading a variety of ER blogs is doing nothing to encourage me. You guys seem universally frustrated and even a little jaded sometimes.

    So my question is, if you could wake up tomorrow in a different specialty (without having to do another residency or anything), would you switch? And if so, what to?

  7. Bruce, I'd never switch from my current residency position in EM to any other specialty. I may be a bit jaded because of the useless crap I sometimes see, but I enjoy the variety and the people I work with too much to switch to anything else.

  8. Been too timid to comment over here much with the baddest of the ER bad boys.
    911 Doc, this is for you.....
    I've been tagged and I've generously passed it on to you! Please link on my name to check it out.
    I'm too technically challenged to embed my URL in a link in the comment section.


  9. dermatology, MOHS surgery. that being said i would always envy the 'real doctors'... those who took care of critically ill patients and made critical therapeurtic interventions. i think all the cash,the completely different patient population, and the good hours would soon overcome this envy however.

  10. I can't imagine doing anything other than EM! As much as it frustrates me and as much as the Governmental mandates negatively impact us (and our "real" patients) and hospital administrators and "clipboard nurses" bug me...when I have one of those days where I'm managing multiple emergencies, it just don't get any better than that!

    The above being said....I agree with 911 that derm and MOHS is pretty sweet (procedural, 100% pay, easy hours, no call, lots of new toys and gadgets....I love gadgets)

    As much as I rag on Radiologists, I think PROCEDURAL Radiology would be great. Depending on the hospital, they do everything from kyphoplasty to central lines, to splenic embolization, to aneurysmal embolization, to angiojet, to arterial angioplasty. They can do some cool things and as the world moves to less invasive treatments, it's a growing specialty.

    Also, there are lots of critical care docs (with variable backgrounds: mostly Pulmonary) who are starting to work shifts like ER docs. I would like it if I was just in the ICU taking care of really complex sick folks.

    I've thought of Ophtho too just because they have an almost 100% pay rate, their call is easy (usually nothing), and I've found the eye more fascinating since med school than I did before.

    But really, I'm not sure I could respect myself each day unless I thought I made a difference (in some way more than just popping pimples, or programming a computer to fix your vision so that you didn't need glasses or contacts). In the ED, I occasionally get a chance to make an important difference!

  11. Dude. Go into Pathology. It's all glamour and macho, high-profile work; it's perfect if you are a 'people person'; and chicks dig it.

    Actually, fuck it all and go into hedge fund management.

  12. most recent wonderfully appropriate use of EMS...

    29yowf with vaginal pain
    Hx: "i just had sex with my fiancee for the first time and his cock is too big... what am i going to do?? i mean i can't marry him with his huge cock... it hurts..."

    no, the fiancee was not me. yes. it's true, this happened to a patient i took care of this summer.

    obtw, i consider myself tagged for the meme or whatever it's called. no problem.

  13. For Cat:


    (h/t Symtym)