Surreality Show

"Most people you meet are asleep, and the ones that are awake live in a state of constant, total amazement" -Joe versus the Volcano

It’s a Saturday night and I’ve got the late shift in the ER. Weekends always bring interesting patients to the mix.

Those of you who aren’t in the medical business would be surprised at the number of people we see who actually don’t want to live. Everyday (and I mean everyday) we see at least one patient and usually more with the complaint of “depressed, wants to commit suicide”. For everyone one of these we see five more with “waste basket diagnoses”, examples of these are: chronic fatigue syndrome, myofascial pain syndrome, hypoglycemia, mitral valve prolapse, there are many more. These patients take many medicines, herbs, therapies and the like. Their doctor doesn’t know what to do with them but feels obligated to come up with a diagnosis so they get one of these labels. They are sick, they have “poor health”.

Back to Saturday, I’m working with 10 patients and 3 have intentionally overdosed and one is thinking about cutting her wrist. Not a good mix.
My suicidal group ranges in age from 20 to 60. None of them want to live.

On the other hand my partner has a patient. Her patient is 37 years old and has terminal lung cancer. Diagnosed originally two years ago, he has undergone numerous operations, chemotherapy and had little success. His tumor is adenocarinoma of the lung (not necessarily caused by smoking) and is very aggressive. He is down to 90 pounds, has a feeding tube and bed sores. He is dying and there is nothing more we can do. He has come to the hospital tonight because he has fired his Hospice nurse and has thrown out his home health team. He is angry with his parents, doctors and family. He is not ready to die. He wants to live. “I’m just not ready”.

It was a surreal moment. I am surrounded by relatively healthy people who want to die and looking at a very sick guy who desperately wants to live. Life is unfair.

It makes me think of one of my favorite movies, Joe verses the Volcano. Basically it’s about a guy in a dead end job, living a dead end life. He finds out he has a terminal illness (brain cloud) and only has a few months to live. So for the first time ever he chooses to live. The movie has moments of great dialogue and symbolism. It has a silly ending but the message is wonderful. I highly recommend you watch it.

The best part is that it’s message is true. So few people actually live life. I have met many people in my 39 years and I have learned this: money won’t make you happy, power won’t do it either. I think it comes down to doing a job you love, having real friends, and not taking the rest so seriously. I think it’s about trying new things without a fear of embarrassment. Most importantly don’t waste a day, you’ve only got a few.

Now “Take me to the Volcano!”.

http://www.youtube.com/watch?v=oGLKnAvzlg4&feature=related

Complaints

Believe it or not, sometimes we in the medical profession get complaints. We always have a response to these complaints. When this happens to me, I tell my side of the story. It’s usually the truth.

The problem is that the patients who complain usually have no grounds to complain. The patients who have a legitimate gripe usually don’t bother. They figured they survived their Emergency Department trip and that’s enough.

Complaints usually break down into three main categories:

Common BS complaints.

You/They didn't do anything for me. If you see any doctor you are guaranteed to get a history and physical. Sometimes that's all that's needed. Somethings can't be fixed in the ER. Long term illness, chronic problems, mental illness, the flu. Sometimes all patients need are a few Tylenol and a big shot of "suck it up". There is just no magic bullet.

I saw a patient 2 weeks ago who had advanced Alzheimer's dementia. He fell at his nursing home and bumped his head. His wife accompanied him to the ER. I could have run a battery of tests and spent thousands of dollars. But the bottom line is it wasn't going to change anything. His wife was frazzled, struggling, watching her loved husband slowly become a victim to this horrible disease. (My wife had to walk down this road with her mom.) I talked to her about our options and we decided to send him back to his unit. No prescriptions, no test. I didn't really do anything other than talk and listen. After our discussion I walked around the bed, put down my clipboard and stethoscope and held her in my arms. She cried for about 5 minutes. The best care I provided that day was giving this lady a hug. No charge for hugs.

The doctor didn't take me seriously. If we aren't freaking out, you shouldn't either. We are trained to identify what "sick" looks like. It actually takes years of experience. One bubble in the IV tubing is not going to kill you. If the monitors start beeping (and you are conscious) it's usually not a big deal. This frequently comes off as callous, but what it really means is everything is okay for now. If your kid got hurt and is crying that's actually a good thing, but it makes mom terribly anxious. If your kid gets hurt and is not crying- that's the kind of thing that gets me anxious.

Insider Heath care tip: If you only see one nurse and your ER doc is acting casually, that is good. If you look up and see more than one doctor and three nurses in your room, things are not going well.

Middle ground complaints

The doctor wasn’t friendly enough. This one really gets under my skin. Most doc’s are polite. The point is we are trying to get some important information out of you. So occasionally I will interrupt a patient to keep them focused. It probably doesn’t matter if you had your tonsils out when you were kid. It probably doesn’t matter that your great grandfather was allergic to shellfish, vitamins are not medicine and cats make you nervous. None of those things ever matter unless we develop some new therapy that involves cats. So if you, as a patient, start rambling, I’m going to cut you off. No offense, but I'm trying to stay focused on your emergency today. Don’t take it personal.

Legit complaints.

It was too cold in the room. Patients are right on this one. The nurses are working hard, walking at a fast pace, usually with a little adrenaline pumping. They sweat easy. The patient on the other hand is forced to strip down to a paper thin gown and sit on a cold examination table. Occasionally we run cold IV fluids and sometimes you have a fever which makes you feel cold. We can really poor it on here. If you ask for a blanket, most times you’d do better knitting one. People are dying in here! And you want me to stop to get you a blanket. Ask for one and you may get a eye roll. Actually my nurses are pretty good at this. I myself have gone and fetched a blanket or two. But we don’t do it consistently so don’t get your hopes up. No kidding people are dying in here so we keep our priorities. For the life of me I don’t know why we don’t keep blankets in the room. I’m sure it’s a cost saving measure. Less linen means less laundry fees.

By the way don’t get cute and bring your own blanket. You will be made fun of for this and all will think you’ve been in the ED a little too much.

We will starve you. There are many reasons why we don’t let you eat. Primarily we want your stomach empty in case you decide to become unconscious for some reason and vomit. You could choke on your vomit and suffocate. You don’t want me to suck vomit out of your trachea and frankly I don’t want to. So it’s really a win/win.

I was kept in the ER too long. This is the king of legit complaints. After I see you and decide you need to be admitted, I do a little paperwork and have the charge nurse request a bed. You think it’s all down hill from here, but wait. Many times there is no bed available. The nurse has to copy the chart, do some more orders and call report to the nurse on the ward. Sometimes the nurse on the ward is available, sometimes not. Your room has to be cleaned. Then you have to be transported (usually by a transport tech who may or may not be available). This can drag on for hours. At our local university hospital some patients have been kept in the ER for days. Patients get angry with me about this but there is nothing I can do. I can crack open your chest and massage your heart, but I can’t seem to get the floor mopped in room 509.

I used to not always feel so powerless. Once I had a tantrum. I went up to the ward found the nurse, the unit manager and the bed and called down to the ED to have the patient immediately transported. This did not go over well. I did get a phone call from the "doctors behaving badly committee". But for a few months things did seem to improve. I tried a similar trick the other night and got a tongue lashing from my fiesty charge nurse and the nursing supervisor. It does amaze me how I can go to hotel without any advanced notice, ask for a room, and the zit-faced, high school educated night clerk can get me in a room in about 10 minutes. Why can't hospitals do that? Hospital administration does not like that question and they don't think my zit-faced clerk analogy is cute one bit.

What people don't complain about.

Whats up with all the cussing and nudity? I have to say the ED is R rated material. We see a fair amount of drunk, drug addled, nut jobs. They scream profanities and have no problem at all walking around naked. You can hear them all over the hospital and I know the deacon and his wife in the room next door are getting an ear full. Sometimes I'll even apologize to patients and their families for the show they are getting but amazingly they all seem okay with it.

The Bill. The cost of health care is insane! Yet people who have insurance seem to willingly pay their copay thinking that their insurance is going to take care of the rest. Keep dreaming. Your insurance company will deny everything they can and ultimately pass this cost on to you. I sutured a kids leg the other day. Took about 4 stitches and about 10 minutes. We hit them up for about 400 bucks. I got about 30 for the gig. I have no idea where the rest is. There is a laundry list of explanations but that's for another time.

The food. Hospital food is a cold, saltless, sterile mess. Yet patients suck it down like it's prime rib. We often see the complaint that "grandma has just stopped eating". Then I'll watch her inhale a Salisbury steak, a carton of room temperature milk and pimento cheese spread like it's the last meal on earth. For what you paid for that meal you could have taken the whole family to Ruth's Chris.

In summary there is an art to complaining in the ER. Basically keep your complaints realistic. If someone is being a real A-hole, call them on it. But keep in mind we only partially control the environment. For some reason, you've wound up in the ER, and that was not your plan, so you're already having a bad day. Expect the staff to be professional but don't expect a lifelong friendship. We do see people in crisis everyday, so it's only natural to get "dumbed down" to all the emotions. It doesn't mean we don't care. Help us out and we will go the extra mile to make sure you get what you need.