Friday, February 19, 2010

Hiding Out


So far so good with my adieu to the ER, but boy, the things I have learned!

I am currently working in what most folks would call a 'doc in the box'... We are an acute care clinic and do not take appointments. We do some chronic care, a lot of worker's compensation stuff, and once in a while, like today, I am reminded why the ER nearly killed me and destroyed my life. If I can get my head out of my ass long enough, and can find someone that likes my particular flavor of bullshit, you might have the opportunity to read all about it in book form (but I am saying this as much to motivate myself to finish the damn thing as to tease it).

Being in charge of a busy ER is a young man's job ("or woman's" I say with fond memories of Life of Brian and the Judean People's Front). There may be ways of doing it without pegging the adrenaline meter all the time, but I never discovered them. The consequences of my years of adrenaline overdose were obvious to my co-workers, but opaque to me. My nicknames during my ER career (mostly given by my nurses) included, but were not limited to, "Speed Racer", the "rat on crack", and "doc zippy". I'm sure there were others.

It's been almost three months now and I can almost sleep without ambien. And as the learned helplessness of working ER has begun to fade to a bad dream I have been pestered with an occasional thought of maybe working 'just a few' ER shifts to 'keep my hand in the game'. Then today happened.

In my refuge here at the doc in the box I mostly prescribe amoxicillin (way too much), and tell people they did not break their arm, leg, ankle, or toes. Today, an elderly gentleman came in after falling and sustaining a bad scalp laceration... I was back in the ER.

His wife, every bit as intelligent and bull-headed as he was, refused every recommendation I made, and they went like this... "Sir, I need to call an ambulance for you so we can get you to the hospital for a CT Scan of your brain and your C-spine... First of all, you aren't quite sure why you fell which right there makes me concerned about a stroke or TIA, secondly, your laceration goes down to your skull which I can feel with my finger here, and while I do not believe you fractured it I am concerned you could be bleeding inside your brain, and finally, I need to make sure your neck is not broken... you are holding it like it hurts so this is a real concern, and if your neck is broken you could move it the wrong way and be paralyzed for life or dead..."

Patient's Wife: "No, I will put him in my car and drive him [to the Mecca], but he is not going to this [town's] hospital... we made a pact... I don't care if he dies, he is not going to this [town's] hospital."

Of course I made my best arguments, but I could not force this patient to do anything he didn't want to do and I found myself sewing up his huge laceration after we C-collared him. I did manage to persuade them to get an outpatient CT scan of brain and neck, and, of course this man had an unstable high C-spine fracture. He could have, with a sneeze or cough or turn of the head, died. I was tempted at that time to call Dr. Asa Andrew for advice on how to "lifestyle" this guy back to health, but instead I did the right thing...

I spent an hour unfucking the stupidity of this patient-spouse tandem with near panicked phone calls to EMS and the closest neurosurgeon that would bite. Then a guy walked in with a dead nut, and a woman rolled in in a wheelchair telling me a very long story about a fall and an inability to find any doctor that could handle all her complex medical problems which, of course, meant she needed a refill on Lortab.

It was at this time, as soon as I had the first choice dumbass tucked away, that my desire to "pull a few shifts in the ER" vanished like coke off a whore's ass. Amoxicillin. Nice.

12 comments:

  1. Life of Brian and the Judean People's Front

    Splitter!

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  2. No, it's the People's Front of Judea!!!

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  3. Outpatient "Hangman's" Fracture??...Nice!!!!!
    and why do they call it a "Hangman's" fracture?? Isn't it the "Hangee" that gets the fracture??? Weird...

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  4. Speed Racer---although we miss you in the ED (and have adopted your radio communications) I am glad that you are happy. We need people in "doc in a box"s so that the idiots like the wife will have someone to save their idiot family members. You still rock in my book!
    Love, SuperCooper!!!

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  5. hey brayden's mom,
    hope the move went well! how's junior?

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  6. Yah, about that book, Speed Racer...
    -priceless1

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  7. lynn,
    my book writing name is sammy snail.

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  8. Saw this today. Thought you guys would enjoy reading the comments here.

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  9. Great post!

    Congratulations on your move to Doc in the Box. :)

    Sounds like it's a good thing you were working there that day.

    How can people be so stupid though? "I don't care if he dies..." gee!

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  10. i don't think she was kidding... the life insurance policy might have been more interesting than he was.

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  11. Can I ask a clinical question from the pre-hospital point of view? If a patient did have a C-spine fracture, would a collar help if for some reason it seemed unadvisable to board him/her?

    Case 1, LOL fall, severe kyphosis, spends day and night in an easy chair, no complaints of neck pain, complains of difficulty breathing unless as upright as she gets.

    Case 2, young male intoxicated, MVA, severe damage to vehicle, out of vehicle and weaving around on black ice patches, not responding to directions to stand still, guided into ambulance rather than wrestled onto board for standing takedown.

    Both collared as better than nothing - will at least remind patient to LOOK STRAIGHT AHEAD. Both times had my ass handed to me by medics/ER personnel, as what is use of collar without board?

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