Friday Night in the ER

If you want to see the nastiness and craziness of the world, just spend some time in a ER on a Friday night. Stab and gunshot wounds, meth overdose, alcohol intoxication and one MVA trauma after another. The MVA (motor vehicle accidents) were 100% alcohol-related the night I was there, and incidentally all young males. After seeing half a dozen gruesome MVA trauma cases, I’m not sure I ever want to drive again!

I just started my ER rotation in a Dallas downtown hospital. This whole week consisted of 12-hour night shifts, 7pm-7am. After 12 hours of work, sleeping for 8 hours, driving time, eating and showering, everything starts over again. Needless to say, I haven’t seen my husband hardly at all. It’s a little strange get off work and then go to work on the same day. Another change of habits this week, I’m eating one meal a day, albeit it’s a BIG meal between 3pm-6pm, the only time I’m not sleeping or working. My cutie cat, the biggest daytime/anytime sleeper I know, have been sleeping with me during the day! So grateful that she’s keeping me company.

Despite the schedule, I’m enjoying myself tremendously on this rotation. It’s a very fast-paced environment, never know who’s going to come through the door. I got to put in my first Foley catheter last night! Actually it was around 2am. I met a really chatty and friendly EMT guy named Barry (not real name) who was eager to teach. Foley catheter placement is quite easy actually. Felt bad for the patient, (intoxicated and had fallen on his head), because it was uncomfortable; perhaps it wouldn’t have hurt so much if he wasn’t struggling and yelling so much. Later that early morning, a drug overdose patient came in, Barry, asked if I wanted to put in an IV in the arm. I said sure, but I really should have said let me watch this one first. The needle went in the vein easily (he had the biggest vein), but I just didn’t quite get how to advance the IV catheter. Luckily, Barry and the nurse finished it off without incidence. Perhaps I should play with the IV needle before I try again. All procedures take a lot of coordination and practice. I also got to staple a scalp laceration, another simple procedure. Interesting pathologies: I saw a case of secondary syphilis and bacterial meningitis.

Interesting side note, ER staff likes to take friendly bets on what the BAL (blood alcohol level) of intoxicated patients are. I’m not good enough to play the game yet.

It’s easy to see why the ER doctors are all so cynical. Of course, many people, maybe even “most people” come to the ER for legitimate reasons. Scattered among the legit patients, there’s the category of people who come to the ER, “looking for snacks,” an euphemism for pain med addicts shopping for narcotics in the ER. After you see the fifth one of the night, you get a little jaded whenever someone tells you they are in a lot of pain and needs pain meds. Even after the most extensive workup all come back negative: x-rays, CT scans, physical exam, and blood tests, I suppose no one can really say whether another person is in pain or not. Without fail, they all get what they come for, vicodin, hydrocodone, and even morphine IV sometimes and then they are sent on their way until next time. You just don’t want to miss the person who’s in real pain and needs meds to control it….but there are some Signs that make you suspicious:
1. Patient don’t have a PCP (primary care physician). So you can’t check his medical history.
2. Same old story: Patient is from out-of-town, forgot his pain meds, accidentally dropped it all down the toilet, the dog ate it, someone stole it, etc. Pain pills are to be treated like money, if you lose it, it's gone, and can't be replaced.
3. Patient says he’s allergic to Tylenol and other NSAIDS or that he’s tried them and the pain is still there.
4. When you examine the patient, he’s in tons of pain, but his vitals are stable. When you leave and then look back on him later, he’s lying comfortably on his stretcher and sleeping.

Although I’m very glad for my month of ER experience, it is definitely not the place where I want to work.