Are there doctors on duty in the ER? - page 3
by ~*Stargazer*~ | 5,467 Views | 31 Comments
Non medically fragile adult woman in her mid forties with mother and grandmother in tow, c/o nausea and body aches x5 days. Previously diagnosed with "the flu or something" (actually viral gastroenteritis, according to the... Read More
- 5Apr 14, '12 by KeeperMomIt always seems like there is that ONE person that thinks he/she is the sickest of the sick at the very same time a level 1 is called, then a 2, then a stroke or heart alert.
I had a lady with end-stage fibromyalgia a few months ago. The same night we had three teens come in by ambulance - 2 were twins, the other was the best friend. One twin died, the friend died, and the other twin was barely hanging on. That was three level 1s that rolled in at the same time on top of the heart alert we just got that expired.
Fibro lady was crying w/o tears like a 3 year old every time someone walked by her room so everyone in the ER heard her. She carried on and on even after I closed the door to her room but even louder. Before I closed her door, she could hear all the commotion of at least 2 of those traumas and could see the activity going on in that pod - it was very obvious that we were slammed.
She had the nerve to ask me in the single most whiniest voice I'd ever heard from an adult, "When is that dam doctor coming in to see me? Is there anyone as sick as I am in this hospital?"
It took all I had to not let her have it. Instead, I put down all the meds and crap I had in my hands and looked her dead in the eye and said, "Well, considering one family lost their father, and a mother just lost one child and another mother lost a child and could possibly lose another in the same night, I'd say YES. There ARE several people that are much sicker than you are today."
I never, ever discuss any patient specifics or even get close but she had just really tried my patience that night. I could not help myself.
- 5Apr 15, '12 by NO50FRANNYI was talking with everyone about this recently, morale is a bit low and we have had a run of badly mangled people and violent crime recently. It is extremely difficult to kill narcissistic rudeness with kindness, especially when you have recently witnessed the raw awfulness of devastating injury and death. I remember wiping a tear from my eye after attempting unsuccessfully to revive a 19 year old MVA, when I returned to one of my acute patients complaining about waiting for one of the doctors to come and cure his viral gastro immediately. I said, "I'm sorry, but I can't deal with you right now" and left for a bit of a break, when I returned he was very apologetic and thankful but only because someone had given him a spray about what had just happened. Esme12, as usual has beautifully prosed the current attitude of the society we are dealing with. Unfortunately it remains up to us to amplify compassion for those who need it, and pacify those who will not listen to reasonable explanations.
We will not cure selfishness- but we can refuse to waste our own emotional energy on it and I am finding this more and more difficult at the moment. I had a woman with a hangover this morning, complaining about her nausea (which paramedics had medicated her for) I explained that unfortunately, I was needed in the trauma room for a badly injured patient and she would need to wait for now, she didn't care and mostly I find, they don't, so I don't bother explaining or arguing much, I just give them the state of play, kindly of course. It goes something like this, "I understand how uncomfortable you are, and how frustrating the wait is, unfortunately, it would be unethical for me to distract our doctors from our dying patients right now, we will keep you as comfortable as we can but I would imagine that you will wait at least four (insert approximate number) hours to see a doctor". Mostly I find nastly individuals hate it when you are nice. The escalation of this particular tactic is usually along the lines of, once again, kindly of course, "Once again I can't and won't apologise for things that are beyond our control, you have been assessed by an experienced clinician and appropriately prioritsed, but if you persist in harassing us, we will ask you to wait outside". I must also mention that this approach requires an invisible emotional forcefield, and denial of energy, refusal to engage- I call it shutting it down. Works most of the time, gives them nowhere to go.
- 3Apr 17, '12 by CrashEDLast week I am pretty sure my whole city had DIARRHEA/VOMITING, and ofcourse INEFFECTIVE COPING! And everyone of them came to emerg! I must have triaged 80 people with the runs in a 8 hr triage shift! Towards the end of my shift I had this gentleman come into my triage room saying I had to go help his daughter in the bathroom.....So I go to the public washroom to find a young woman covered in s**t! I asked her what happened and she said "Are you the nurse, you need to clean me up right now. You didn't get me inside and look what YOU made me do!". (Like I held her hand and told her to deficate on the wall, get it on her clothes, then proceed to wipe her hands on things!) She had diarrhea on her clothes, hands on the wall.....it was a mess you would expect from a child! I for a moment thought maybe she was special needs....until I realised Nope! I politely gave her a attends, and 2 johnny shirts and towels and such to clean herself up. As she bluntly told me that sh***ting herself was the only way she could get a bed inside! BOY WAS SHE WRONG, I told her that incontinence was no reason to rush her in because she was not dying, and there were sick patients inside! She was Irate and looked at me and send "Next time ill just have to go in the chair". I wanted to strangle her!!!! The girls inside were running off their feet, it was a "sickie day"....in which every second ambulance that came through the door had someone trying to go to the light! People like that drive me nuts!!!!!!!!
GREAT JOB PLAYING THE SYSTEM LADY, I STILL AM NOT BRINGING YOU IN! TAKE AN IMODIUM AND LEARN TO COPE WITH LESS MANIPULATION !
- 1Apr 17, '12 by sharpeimom GuideQuote from thelema13nerve block for a toothache? we hit 'em with 60mg toradol and a referral for a dentist, and education on proper dental hygiene.:d
you know, not everyone who gets a toothache has lousy oral hygiene habits! i'd rethink that one if
i were you. i inherieted poor teeth (in my family there are two types of teeth. the type you have
all of when you're 110 and the ones you nurse along with extra brushing and extra time in the dentist's chair.) guess which ones i got?
my teeth look fantastic on the outside -- as well they should, considering what my parents and i have spent on them. i've had fluoride tx, drops, tablets, checkups q. 3 months since i had even
one tooth, crowns, veneers, porcelain and gold fillings, and on and on and on. balance all that against
having had to take heavy doses of anticonvulsants since age 13 months when my first aneurysm ruptured.
i lost a temporary crown (i swallowed it) over one 4th of july weekend and it ached so badly nothing i tried even took the edge off my pain. my dentist is also our friend and neighbor. i
ended up getting a nerve block in their kitchen until he could fix it properly the first
of the week.
teeth can really hurt!
- 1Apr 17, '12 by outrunningzombiesI started my shift at 7 am and one of my patient began to vomit blood at 710. He immediately went up to the resus rooms. All of my patients can see each other, and you know there was one guy who was in for a migraine who started whining about how I hadn't even talked to him and why was this other patient getting all of my attention?
- 3Apr 18, '12 by thelema13Sharpeimom: I know teeth hurt, having all my wisdom teeth extracted with just local anesthetic. Just in my area, the teeth to tattoo ratio is a pretty good indicator of socioeconomic status. I give education on proper hygiene because most of them need to realize that smoking cigarettes, drinking nothing but Mountain Dew and never flossing do contribute to dental caries. Common sense is not common these days.
I also give weight loss info to obese patients. It's funny to me when I go over their health history and I mention obesity, they get upset and throw their arms out- not up, they are too heavy to lift straight in the air- and state "Oh, yeah, I am really obese (sarcastic tone). It's water weight, I thought you were in the medical field."
I actually took admission orders on a patient last week, and her diagnosis: morbid obesity. It saddens me when there are more over-sized wheelchairs available than regular sized wheelchairs.
I really try to educate my patients. Especially the ones that complain like many of the examples above. I always open my conversation with the line "what is the emergency today?" When I hear scraped knees on a 13 year old, or a 35 year old afebrile man-flu with mother in tow, or that 'my elbow hurt, my elbow feel funny,' I have to teach them the proper use of the ED and clinics. I hate that I have to half-heartedly apologize time and time again for the length of stay. Sorry I did not get you a Coke with ice, I was helping the doc put in a chest tube on a 90% collapsed lung. Sorry I did not help you go to the bathroom, because how in the world does a 38 year old with nausea/vomiting go to the bathroom by themselves? I hope that when they hear the thick sarcasm coming out of my mouth, they take note of what is transpiring. Yes, the first 3.5 hours of my shift I work go to taxes, medicaid/medicare and social security. Yes, I am upset about not getting a raise, ever. Yes, part of that is due to unpaid medical bills. I am totally ranting off topic, sorry.
Part of the job unfortunately.Last edit by thelema13 on Apr 18, '12 : Reason: typo
- 0Apr 18, '12 by FootballnutI just wrote a whole post on this topic and then lost it when I went back to another page. It was quite therapeutic. Thanks for the opportunity. And now for what I need to say in the real world . . .
"We will be happy to see you as soon as we can. We will start _____ while you are waiting to see the doctor and I expect your wait will be _____ hours. Thank you for coming to see us."
- 2Apr 19, '12 by Roy Fokkeri have posted this before:
wife comes in at 5 am with husband in tow for intermittent nosebleeds x 2 days. yes she is on coumadin. they get my last hallway bed open (should give you and idea how busy we were for 5 am). i give the wife the same advice the doctor will give: "pinch you nose real hard, like so and hold for 20 minutes." i know this can be a challenge sometimes [i get frequent nosebleeds too] so i mcgyver up a nose-clip (two tongue blades held together with rubber bands - works pretty good ) pt. is annoyed and frustrated but bless her heart, she's a patient trooper. her husband on the other hand, is an absolute jerk. in my face every 10 minutes "why hasn't she been seen yet".
guess i'm chopped liver... but anyways i tell him (the first dozen times) : "sir, i'm real sorry but we're real busy right now and there's only one physician on duty. we've called in additional people. the doc will get to her when he can. i've already sent off her blood work and her vital signs are stable."
"this is crazy! what if there was a real emergency?!"
well, you kinda answered your own question there now didn't you sport?
of course i didn't say that out loud... but i was tempted!
and all i can think of to ask is: "hmmm, wonder who raised them to be this way..."
Quote from sharpeimomi'd rather have all 8 fractures i've had in my lifetime - together - than suffer through another toothache or earache!teeth can really hurt!
- 1Apr 19, '12 by hiddencatRNI think it's interesting how many crabby waiting patients use that terminology: "are there any doctors here today?" Like, is it supposed to be clever, or shame us in to realizing, gosh darn it, we DO in fact have doctors so why aren't they taking care of THIS patient RIGHT NOW? It's really always said in such a smug way.
Had a patient who was frequently brought in by parents for BS reasons who had a pretty long wait one night when lots of kids were pretty sick. Mom came out to my desk within 5 minutes of being placed in a room and said "There are no doctors here tonight?" And I said "Why yes, there are, and they've been very busy with very sick patients all night." And went back to my charting.
The thing that frustrates me is the talk of moving towards satisfaction/ratings based reimbursement. Because these folks misuse the ED, have long waits, and are often VERY unsatisfied to be sent home with nothing other than instructions for care of a viral illness, yet still take up our time and resources. So will we not get reimbursed now because the vomiting x 1 had to wait a few hours to be given juice and keep it down?
A few months ago we had a pretty scary and dramatic patient rushed back through the waiting room. A parent in a room looking towards our trauma room kept pulling her curtain back so she could enjoy the show. I kept closing her curtain and she kept opening it right back up. Guess who still complained about the wait to see the doctor?