Patients, O Best Beloved, know more about the ER than I do sometimes.
I saw a barely-legal-to-drink youth whose habit is to go through a case of beer and a half a fifth of whiskey a night. He stunk of alcohol. He wasn't lying according to our drug screen when he said just alcohol and pot, but that was hardly a comfort. He vaguely remembered getting into some kind of argument. And then he remembered his friend wrapping up his bleeding head and taking him to the friend's house, where he passed out. And then he called his mother, who took him to the emergency room. CT of the head and orbit. X-rays of his aching jaw (no blood, no loose teeth). We assessed the probable source of the 5-centimeter laceration through his eyebrow. At 1600, the PA told me to leave. "This will take forever to stitch up. No point in you waiting around." I'd only be waiting around all day.
A litte baby boy, one day of congestion, no fever, eating well and making wet diapers. Patient is a playful, interactive, smiling and cooperative infant boy. Worried mother. I wonder if I explained too much, that it was good to bring him in when she was worried but that he wasn't sick enough to warrant any treatment at all.
Chest pain, in old and young. Three quick sets of cardiac markers an hour apart and a stress test, then home.
Back pain, chest pain, abdominal pain, a pelvic exam for spotty vaginal bleeding (all she wanted was a pregnancy test - negative), suturing on the man who accidentally stabbed himself in the shin with a box cutter. Half the day staring into space and unsure what I was supposed to be doing, the other half running around with a chart in my hand, unsure of what I was supposed to be doing. But I did do a "good job" of suturing and the wound looked nice when I was done. I like to suture. It reminds me of making Barbie clothing.
Is that so very wrong, O Best Beloved?
Moral dilemmas today: none, really. Although I overheard a lot of talk, and I am still disturbed, as I ever am, by the sterile environment of the hospital, the warren of corridors, the way that one can never tell if it is dark or light or stormy or clear. It is a womb of ceramic and linoleum, its amnion scented with alcohol scrubs and the aroma of freshly-sterilized air, cool in its embrace instead of warm, the outside sounds drowned by the heartbeat of monitors. It is unshakable and unchanging. It frightens me, as I journey through it, wondering how my protoplasm is formed and nourished. What will I be birthed as, when it comes at last to an end?