Wednesday, March 28, 2007
What I do for a living...
I always walk through the automatic glass door entrance to the hospital with some anxiety. As I walk past the ER waiting room, I count the number of people in the chairs, hoping to gauge what kind of day I will have. How sick do they look? A mild cough? Are they holding a bloody towel to their hand or forehead? Does anyone look to be crying? Of course, I cannot hear them. My headphones are plugged firmly into my ears, hoping that music will calm me or wake me up, depending. I walk down the linoleum hallway in my comfortable nurse shoes, my scrubs, carrying a large bag filled with various snacks, and in my hand a cup of hot, sweet coffee, hoping these things will sustain me through the next twelve hours. I swipe my badge through the time clock and greet my coworker's in the Fast Track.
The Fast Track is a department that works directly with the main Emergency Department. We are a team of two physician's assistants and three nurses that see the non-emergent cases. While we take care of the migraines, the lacerations, and broken bones, the main ER can help the chest pain's, the strokes, and the drug overdoses. It's a pretty good system.
People come to the ER with non-emergent cases for a variety of reasons. Lacerations and broken bones make sense to me. I would go to an ER if I thought I broke a bone or needed stitches. But the other complaints baffle me. "I've had a cough for 10 days". "I've had neck pain on and off for a year". I always ask them, "Why did you come to the Emergency Room today?" I understand that some people do not have a doctor or even insurance. But I'm curious to know, why did they choose that today would be the day they decided to come in as an emergency? If you've had neck pain for a year, why not get it checked out six months ago?? My favorite non-emergent complaint of all time is the young guy who came in saying, "I smoked pot and then drank a Red Bull and now my heart is beating fast." My diagnosis: Can't handle his high. My cure: Sit him in front of the television with a bag of Doritos for an hour. He'll be fine. Instead, he pays a $500 fee just for walking in the door then the PA gives him another drug to help "calm" him which he'll probably just get addicted to. As he was walking out, I told him he shouldn't smoke the dank if he can't handle it. He said, "No, I'll just take this drug whenever I want to smoke pot." Great.
We do see a lot of drug seekers. Many claim they have been in car accidents or have migraines. This is usually a guarantee to get at least a shot of pain medication. But you get a sense of who is seeking and who is really in pain. The seekers will ask for their drug of choice by name and claim that they are allergic to over the counter medications or "those don't work for me". One kid who claimed he had been in a car accident asked me if I would give him a shot of morphine because he was "in such intense pain". He asked me this as he was spooning and snuggling in the guerney with his girlfriend. Ummm, no. Another guy was recieving a shot of Dilaudid (ten times stronger than morphine!) for his "migraine". He requested that I give it in his thigh (I would normally go for the glutes) and when I injected into his muscle he closed his eyes, started to massage his leg, and started making "OOOhhhh, AAAHHHH" noises like he was about to have an orgasm. He made me feel dirty.
But, today is a new day and as I put my bag away, check to make sure I have enough pens, some tape, alcohol swabs, and a pair of scissors in my pocket, I take a deep breath and greet our first patient with a smile. I know that in twelve hours I will walk out the door, tired, maybe a little bit sweaty, and climb into the passenger seat of mine and my husband's car. My husband at the wheel with a smile, a kiss, a "How was your day?". I can go home, put my feet up, sip a glass of wine, and comfortably discuss the day with my husband. We talk about his work....Oh, that's a whole other blog...