Adventures in the emergency room

After working 30+ hour shifts in the CCU, I thought a 12-hour shift in the emergency room would be nothing. I was wrong.

First of all, I started with night shifts. There seems to be no easy way to switch your body over to being awake all night. I tried afternoon naps, but that didn't work. After three nights of work in the ER, I was finally able to sleep nine hours during the day. Too bad after four night shifts I now have to flip to doing day shifts!

The ER is an interesting place. I'm used to being upstairs where someone else has already decided that someone's problems are serious enough to be in the hospital. My biggest problem in the ER is adjusting my "bullshit meter". Who is in the ER for secondary gain? It's not the coziest place in the world, but it does offer a warm place to sleep and as many 4 oz containers of juice as you want. I've had people come in saying "I had a seizure" or "vomited up lots of bright red blood" or "I want to kill myself!" Individually any of these would be a serious complaint, and I quickly started to realize that they know if they say one or sometimes all of these things we can't kick them out the door for at least a few hours. Yes, the people who say these things are usually drunk and sleepy. However, they are also symptoms that are more likely in people who are drunk, and the fact that they're sleepy would normally be more concerning. Did they overdose? Try to kill themselves? Hit their head and lose consciousness? Probably not, but I worry and often rely on the judgment of those who have more experience.

The other thing I find interesting is that people come to the ER in the middle of the night for the most mundane things--sore throats, tooth pain, a cough that's been going on for a week. They know the wait is shorter if you come at 3 am. I know that this is a symptom of our broken healthcare system. I myself haven't seen my primary care doctor in two years because it's too darn hard to get an appointment. Sometimes the wait for a sick visit is a week. However, there are people who keep coming to the ER for the same complaint, and I ask them why they don't go see their primary care doctor in between visits. Usually, they say "I didn't think about going when I felt okay." It's probably silly of me to try to change the system one person at a time, but I sit down and tell them about the role of the primary care doctor. Despite the frustrations of the system, that person is the main coordinator of their health. If they continue to have complaints serious to them but not serious enough to be admitted to the hospital, they're not going to get fixed until something very bad happens. I might be imagining a light bulb going off in their head, but hopefully my pleas to go see their regular doctor are heard.

One more week until my first vacation in eight months! Can't wait!