I hauled a patient the other night that started out with a seizure, came out of it with a thunderclap headache to her right temple, could not talk, but had equilateral extremity sensation and strength. She also lost consciousness en route.
Everything I knew screamed stroke, but the signs weren’t typical by a long shot. This might have been her problem.
That was one scary ride for me.
I dunno. If you’re gonna die, having the satisfaction of a good dump at the very end of things isn’t a bad way to go, IMHO.
If it’s good enough for Elvis, then it’s good enough for me.
I know you said you are good at calming people down, but what was your best riposte/verbal smackdown to a mouthy or unruly patient?
How do you handle phobias?
I have a huge needle phobia, and had to go to an ER with massive pain in one knee. The doc wanted to “tap” it, and I freaked out - my paperwork said I had a panic attack. I seem to recall that a lot of people trouped through, and I suspect I was a “teachable moment”. Later diagnosis was that it was gout, and has been handled with indomethicin and large quantities of water. The doctor friend who diagnosed it told me “young guys love to do that sort of thing” - the most “interesting” approach, like tapping a joint.
I think the rumor was that straining/Valsalva maneuvering involved in forcing out a big dump would bring on a heart attack.
Have you ever had a child or teenager die under your care?
Have you ever treated a sexual assault victim?
Have you ever delivered a baby?
Have you ever been in an “is there a doctor in the house?” type of situation (like someone is having a medical problem on a plane and you’re one of the passengers)?
And my next question is kind of long and involved, and you might get bored reading it, and if so I apologize, but:
When I was in high school I was dating this girl who had to go to the ER one night with severe abdominal pains-- to the point that her parents decided to take her to the hospital when she started screaming. This was on a Saturday night; she told me about her experience when I saw her at church the next morning. Anyhoo, she was pretty traumatized over the experience. I remember her talking about the doc examining her and her saying, through tears, “he made me take off all my clothes.” I think she honestly felt that she was sexually violated. The memory of the pain in her voice still haunts me to this day, 25 years later. My question: Do you think anything untoward went on in this situation? Do you think that examining a shy and modest 15-year-old requires more discretion than you would give another patient? Or is it all just business?
You mentioned that hours are regulated for ER residents. Are there similar regulations for supervising (attending?) physicians in the ER? I used to work a day job with an MD who moonlighted in the ER some evenings. He would come in to work the next day after working all night in the ER and was understandably very tired. But I assume that he was also fatigued during his all-night stint in the ER, since he had just worked a full day at his other job. Somehow I have an easier time accepting long shifts for ER residents because they are being supervised. Are there any rules regulating the hours of supervising ER physicians?
Have you ever been on duty (or called in suddenly) for one of those “big disaster happening, notify all the ERs in the area that they’re going to get slammed big time” events?
Like, a major wreck that involved hundreds of cars, or a major ice storm, or an earthquake (I’m guessing ice storms are few and far between in Southern Cal :p).
Have there been times where you’ve practically popped a blood vessel holding the laughter in (until you could get away from the patient and give a big guffaw)?
Do you think you’ll always be an ER doc or do you envision going into private practice one day? Are there career ER docs?
Doogie? Is that you?
(No offense intended to you, your friend, or her experience–just that this pretty much exactly mirrors the plot of an old “Doogie Howser M.D.” episode, where his 15 year old girlfriend had abdominal pains and he was the only doctor available to examine her–she was mortified that he saw her naked.)
I’ve been taken to the ER a couple times (knife wounds, broken ankle) so first off, thanks! I guess I’ve been “lucky,” because I never had a terribly long wait for treatment. (Now that I think of it, both injuries occurred on Sunday, so maybe that helps.)
I think ER and Scrubs both did shows based on the urban legend that ERs get really busy/crazy during a full moon. In your experience, is there any truth to it?
Any particularly funny/amusing stories you could share with us?
I try really hard not to escalate things with a verbally abusive patient. I usually will just say “ok, I’ve heard enough” and turn around and walk out.
Meh, if you’re there for me to help you, then let me do my job. If you can’t take a little needle action then you’re certainly free to leave. Most of the time if someone is really freaking out and I think the delay in their diagnosis could be life threatening then I’ll sedate them for whatever needs to be done (MRI, CT, etc).
Occasionally. Always tragic when it’s an otherwise healthy child. Occasionally a child with life long developmental and physical problems will die in the ER and sometimes it almost seems like a relief.
Yes. Thankfully we have Sexual Assault Nurse Examiners who do the evidence collection for sexual assault victims (which requires special training and can take a few hours). My primary concern in those cases is dealing with any physical injuries.
Not since my month-long rotation through Labor and Delivery when I was a resident.
Once when I was a medical student on a plane they asked if there was a doctor on board. I grabbed the flight attendant and told her I was med student and to only get me if there wasn’t ANYONE else willing or able to help.
Things were probably quite different 25 years ago when doctors tended to be more paternalistic. I try to maintain my patients’ privacy while examining them, but it is important to be fully unclothed and in a gown for some complaints. Particularly abdominal pain.
No. Physicians who work full time in private practice in the ER typically don’t do more than 160-180hrs in a month (I usually average about 140-150). It sounds like your MD friend is moonlighting to make extra money and has to fit his shifts around his full time schedule. This is dangerous and few ER doctors would do that.
Wrong USC, but no. So far I’ve been lucky in that regard. We’ve had a few alerts that turned out to be nothing. Plane crash at the airshow turned out to be 4 people in a prop plane, that kind of thing.
This happens on nearly a daily basis. Usually I can’t wait to find a colleague to say “Guess what this clown over here said!”
This is a common question too. Emergency Medicine is its own specialty. I am residency trained to work in an ER and nowhere else. I wouldn’t be comfortable in any kind of private practice. I and most of my colleagues (make that ALL of my colleagues) are career ER docs.
How do ER doctors regard surgeons? Again, I’m going off Scrubs, where Dr. Cox had contempt for the surgeons. I’m sure you don’t have contempt, but is there any sort of friendly competition?
Still call 'em GOMERS?
No not really. My practice seldom overlaps with a Surgeon. The only time things get contentious with other specialties is when we have to call them in to see a patient and they either don’t want to come or they disagree with why I’m calling them.
I don’t use that term much. Honestly I don’t think I hear any one use it too often any more.
Actually, on the acute care unit where I work, we run/jog regularly when there is an emergency call.
Of the patients who present in the ER complaining with chest pains and related symptoms, how many would you say are really having a heart attack, as opposed to biliary colic, pancreatitis, kidney stones, and other problems?
Good question. I’d have to look at the research to give you an exact number, but it’s surprisingly very low. I’d guess less than 5% are actually having a heart attack (myocardial infarction). A higher percentage (maybe 15-20%) are having heart related pain that isn’t infarction (unstable angina). The rest are total unrelated to the heart and/or we have no idea.