Wednesday, June 13, 2007

primary care provider: ER

I can't help but wonder at what point did the word "emergency" lose it's emergent status. When did emergency go from "I'm about to die" to "I don't have a PCP." says this about the word emergency:

" e·mer·gen·cy
1. a sudden, urgent, usually unexpected occurrence or
occasion requiring immediate action.
2. a state, esp. of need for help or relief, created by some
unexpected event: a weather emergency; a financial emergency. "

Anywhere in those definitions does it emply that an emergency is something pertaining to a chronic condition you've had for 3 years? Or what about those grown adults who think their cough and sniffles is an emergency. The ones I really love are when a girls come to the emergency room for a pregnancy test. Since when is that an emergency?!

Sorry, but none of those things fall under the definition of emergency. The general public has morphed into a starving parasite, eagerly awaiting the next presciption of hydrocodone, or the emergent diagnosis of fibromyalgia (that's another rant in itself). It has become so easily accesible to be apathetic in one's own healthcare, which is why many people don't put the effort into finding a PCP, or even at the root, keeping a job to make the money to have a PCP. I can't seem to find the logic behind using the emergency room physicians as your family doctor. Where's the reasoning? It's certainly not because the emergency room is more affordable. Oh wait, maybe that is the reason. Pardon my forgetfulness, you don't have to pay for emergency room visits.

Maybe it's because of the flexibility of office hours. Unlike a doctor's office, the emergency room is open at 3 in the morning to take care of your >5 yr old back pain, or that bite that mean ol' spider left you. How ignorant has society become to think that these things fill the quota for an emergency! That's mainly the people who drive themselves to the ER, and not to mention the anomaly of those who call an ambulance for reasons as lame as those. It's abuse of the EMS system!

On a personal note, growing up, my parents rarely shipped us off to the emergency room for emergencies we had as children, and yes, we did have them. Even when I tore the flesh off the bottom of my foot and left a trail of blood behind me, my dad doctored it at home. Oh wait, my parents did take my sister to the ER when her skull lost the fight with the brick wall, that's right, and the only time an ambulance was called was when CPR didn't seem to be working.

Maybe this is just my opinion, but when your heart suddenly stops beating, or when a bullet takes a trip through your body, or your car takes a trip off the bridge, to me, those are emergencies. A host of other situations fall into that category, to many to list, but each just as true to the definition of emergency as the one before it.

But I suppose that life in the ER wouldn't quite be the same without the misguided patrons wanting an STD check at 5am, or a refill of meds, or dang, those spiders sure do a lot of biting. There's most likely no escape from the warped view of the ER, and certainly no going back. But at least it's there for when people really need it.

tornado alley

Perhaps I have some sort of disorder, perhaps there's never been research done, or an article on PubMed about it, but I believe I have a disorder: I absolutely am in love with my job. It really does make me so happy to be at work. There's always something new to do, or see, even smell. I just love to be there.

The other night EMS called to tell us about a GSW to the head that was coming in. I've worked a couple of those before, and typically those injuries are quite bad, and serious. Like the time the 22 year old boy got shot standing out in front of his house; a whole crowd of onlookers, but nobody confessed to who did the shooting. The pictures from the cat scan on his head showed an entry point towards the left occiput, obvious fracture and hemorrhage, but from that point and across the brain diagonally to the right frontal lobe was a path of destruction. Texans know what it looks like after a tornado has touched down; you can follow the path it took by the devastation left behind. That is what this boy's brain was like. It was as if a tornado rampaged on the playground of his control center. A little chunk of metal tore through his gyri and ventricles, like a frustrated child ripping paper. This boy lived to make it to the unit, but his future wasn't quite so bright; more like a sky with blackish rain clouds.

A couple of nights later I was working up at the front desk, answering the phone, "Emergency Room. Can I help you?"....."Is this the ER?"......"Yes ma'am." At least she can't see me roll my eyes. Anyway, two young guys came up and asked where they might find a certain patient. They gave me the name, and I looked in ER roster. Hmmm...that name didn't come up. But wait, it sounds so familiar to me. Oh yeah, that's where I remember it from. It was the boy shot in the head. He went to ICU. I called 1671 and found out the room number. Look at that, he was alive! What a great day! It was my complete pleasure to give them directions to the third floor, and I felt good about it; at least he was able to have visitors.

So is it really a disorder? Maybe it's just a twisted passion. Maybe not even twisted. I consider it a beautiful gift that I actually love what I do. Even though it may plunge me into the ranks of the freaks. Hey, maybe they'll write an article about it and then I'll be famous!

John A. Doe

Last night was so exhilarating! Within the span of just under two hours, we got in 5 helicopters. I was on the helipad getting one when a co-worker ran up the four flights and told me to take that one down and he'd stay for the one that we could see just past the buildings. It was crazy! This particular patient was brought by PHI (who, by the way has the coolest helicopter ever...loads in the back, and they have their own stretcher), and we had to unload hot - that means no waiting for the blades to turn off, you just charge up there and duck! This guy was a level one. I always love it when we have to unload "hot", it's so cool. I only wish that the patient had been concious so he could experience the helicopter ride. But if you were awake, it very well might have been terrifying to be strapped to a cold, hard board, on your back, with a mask flooding your face with oxygen, not to mention you have a stiff plastic tube down your throat and someone, not you,is making your lungs grab the 02. And just imagine, you're pulled out of the bird, blades furisouly making rounds above you, you're swung around going feet first down a ramp, rushing to the elevator. Once at the first floor, you swing again into the hallway, and rush again -chooosh, chooosh - we're still breathing for you. We push you into the trauma bay, bed one, and if you thought all this before was crazy, nah, it's just beginning now. Before you're even moved to the bed, there's ten people staring down at you: pushing, pressing, and poking on you. There's a lady doctor at your head, checking placement of that tube that's letting you breathe. Another couple of doctors are pushing your stomach, checking for rigidity; shining lights in your eyes to see if your pupils say hello; pressing all the way down your spine to check for deformity; moving a chilly stethoscope all over your chest, checking to hear S1 and S2, breath sounds bilateral and clear. Meanwhile, I'm here putting stickers on your chest, connected to wires that will give us a picture of what your heart's doing. I'm squeezing your arm and listening for your pulse to find a blood pressure - not good, it was hard to find - it's 42 systolic. Then I grab your right arm and pull it straight, looking for a good vein. Ah, there it is, in your a.c. If you were awake, and sometimes anyway, I'd tell you, "ok, you're gonna feel a big poke, one..two...three" and on three a large bore needle sinks into your vein; yep there's a flash, now I'll take 7 tubes and watch your blood gush into each one of them. Oh! it's been 5 minutes, time to head out. You're connected to the Level one, rapid infuser, which we have to drag behind us through the hall. We make a procession, like a staunch parade, you leading the way, trauma team marching behind. Pretty soon, you're on the operating table, and a whole different crew is taking up the fight for your life. I see you through the small door window - I hope you make it. Pushing the bed in front of me, headed back to the ER, I think about you and wonder about your family, wonder about what you were doing before this, wonder if you'll open your eyes again. To us, you had no name, so we gave you one: The infamous John A. Doe. Somehow the middle initial softens the edges, lending a sliver of personality to the generic, "we don't know who you are" name. Elevator doors open again, and again I'm back in my home and look, there's another person in three who needs attention. Roll tape.

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