Saturday, August 4, 2007

Hating the ER

A person comes in with a set of symptoms on Wednesday. I present the patient to the attending physician. I'm told to order these tests, prescribe these meds. A person comes in with the same symptoms on Thursday. I present the patient to a different attending physician. He asks what I want to do next. I say, "Order these tests, prescribe these meds."

He says, "Why the hell would you do that? Does that make any sense to you?"

I want to say, "None of this makes any fucking sense to me. It would make sense to me if the group of physicians working in this ER got together and decided how the hell they were going to treat these patients. Perhaps, they could even peruse some research. It would be almost like they were practicing evidence-based medicine, rather than just pulling treatment plans out of their asses."

But, instead, I say, "I'm sorry sir. How would you like me to treat this patient?"

The ER doesn't have a staff bathroom. When I asked about it, I was told they use the bathroom back by the gynecology patient rooms. I'm not using that bathroom. When someone asked me why I would bother to walk all the way out of the ER to pee, I picked up a stack of culture results. I said, "See this? This is a pile of paperwork from the lab detailing exactly what the patients who use that bathroom have growing in their crotches. The lab knows this because I just spent the last three hours doing pelvic exams on these women so I could send them a bevy of malodorous samples. Having visited those crotches and having read these results, I will not be using the same bathroom they do. I realize that we all share the same public bathrooms elsewhere. I realize that the people who use the staff bathroom may be growing all the same funk. I don't care. I'm not peeing in there. Not tonight."

Oh, and last night, Capt. Kidney Stone threw up. On my arm. The flowers are for the young man from environmental services who cleaned it all off the floor and walls.

I hope he's the kind of guy who appreciates getting flowers from a lady.


Susanlee said...

There's a really terrible doc in the ER here who everyone avoids at all costs. For my nephew, who was 2 at the time and had whacked his head he prescribed "no alcohol, no smoking, no sex. wear a seatbelt and eat your vegetables." Seems to be an epidemic of assholes. That's why they're in the ER, no one with a choice would ever see them.

Anonymous said...

I have the same frustrations in my job hun. You do things one way and then they tell you for the next client to do it a different way until you want to crack management skulls.
Then with this new zen thing i'm trying i simply do my time yes and no and three bags full to them and learn what sort of a professional I don't want to be.
Much hugs hun, hang in there xoxoxox

Robyn said...

Public toilets are a little disconcerting sometimes. I can certainly understand your refusal to share a toilet with the gynocology department. ew

Maria said...

Good plan. Have you gotten to the part yet where you find yourself taking on symptoms of the people that you treat? I mean once you see up close and personal just how fucked up the human body can get, it sort of takes root.

And, that sucks. Every physician has their own game plan and they expect you to be on board. This leaves you playing Jill of all trades on a regular basis, trying to remember that this one is test happy, this one believes in waiting and seeing....

The ER is the hardest place to work (or to be for that matter, unless you are a gunshot victim) because it is incredibly busy, staffed by those who have to be able to treat a whole range of symptoms on a dime, and I've found it to be the place where it is easiest to lose your sense of compassion. There is just too much on your plate at all times and so little time to process it.

Hang in there. You are doing splendidly!

Mme Benaut said...

They're lovely flowers and he will enjoy them. It's always tough working with people who have authority over you who are completely insensitive - it is their little power trip for the day. Those who can only lift themselves up by putting others down under the guise of "teaching". Your approach was the right one though little Terroni.
I had to google Akathisia and it sounds about right to me - I was going to say serotonin syndrome - but then, I'm not a doctor, just a compulsive reader - the kind that reads toothpaste tubes!
Sounds like you're doing an incredible job though: I'm impressed with the 85 questions! Which hospital are you working at?

CS said...

I don't know how you stay pleasant with that. How galling to have someone talk to you that way. Nice touch with the flowers.

Rich said...

Welcome you are entering the medical hiarchy beware!!

Story I went to the ER and presented with round rash and senory soreness in the L3 distribution of my upper leg. Atending says it's sciatica - I tell him it's sensory no motor symtoms it's superficial I say - he ignores me and and sends me home. Next day I go to my Primaray care doc, he looks at it and says "you have shingles". Shingles it was. Long story short Stay out of the ER unless you're dying.

Terroni said...

Even this medical student could have diagnosed that one, Rich. Yikes.

Anonymous said...

As someone fortunate enough to have primo insurance, it never cease to amaze me the battery or tests I receive. And I be battered.

Those with good insurance get a lot of unnecessary testing done and those with no insurance are lucky if someone will even give them a proper examination. It's messed up. I'm for Universal healthcare. We no longer treat symptoms in this country, we treadt pocketbooks with humans attached.

Melanie said...

this is *so* much fun to read about. especially since i know i don't have to be in your shoes. :D

my daughter is more on fire than ever about it, though. reading about it here just seems to make her more excited about it all.

Terroni said...

Hi, Lorelei! You should be excited about it all. I'm bitching a bit here. But, as I take the good with the bad, I realize I'm so incredibly lucky to be doing this.