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Give me my G-D- Tussinex! - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
Give me my G-D- Tussinex!
Almost slept in too much today, O Best Beloved; I woke at 0445 after hitting the snooze at 0330. I was only fifteen minutes late for the 0700 shift in Indianapolis. I am so tired now. So sleepy. And I will not have my 200 words written for tomorrow; I will have to submit them between 1600 and 1730 or so. Tomorrow between working and going to a party with the Residency Folks at a charming little biergarten downtown. Angel is coming to be with me. Perhaps it will be better than the last time I was at the charming little biergarten; perhaps they will let us drink decent beer.
Today I arrived at 0715. At 0810 the first patient rolled in: hit in face by someone, either her son's cousin or her ex-boyfriend or both. I don't ask certain questions. In any case, she didn't require much time to see, as it was a quick exam followed by pictures of her facial bones, the application of ice, and a see-you-later. She'd already talked to the police. She was followed by a girl, about 18 weeks pregnant, with abdominal pain. Pelvic room please.
Apart from the smell (I am overly sensitive to personal odors; I am good at ignoring them because at any given time about half the population, including those near and dear, smells strange to me) her exam was unremarkable. A sharp contrast from the pelvic-exam before her, two days ago, when I was greeted by a wash of thin, greyish, unhealthy-looking vaginal discharge as soon as I opened the speculum. Trichomonas positive, O Best Beloved, and then I had to explain to this girl, who had already borne one child, that yes you can get trichomonas from a simple in-and-out, particularly if that in-and-out were unprotected.
"Trich." She was in shock.
Pelvic exams are an unfortunate reality of the ER, and I do them on all deserving comers, rich or poor. There is something about the technical aspects of hunting for the cervix with a metal spatula, of trying to get the becursed thing out without pinching the collapsing vaginal walls, of burying two fingers to the near knuckles in blind search of the elusive cervix and whisper-faint sensation of ovaries - there is something about all that work that ensures that this is anything but an erotic experience. Not to mention, O Best Beloved, that if any part of a well-kempt woman is going to stink, it is the nether regions.
Did I mention that pelvic exams are a necessary evil?

Got some more story from my patient. She'd been seen at another hospital, three weeks ago, and diagnosed with a urinary tract infection. Uncomfortable in ordinary women, must-treat in a pregnant lady. Preferably before she develops pyelonephritis and endangers baby and mother in one. It is not advisable to do as this young woman did, and opt for a pack of cigarettes instead of a prescription for penicillin. Urine leukocytes: packed. Automatic admission.
Little boy attacked by a windowsill. Standard child-getting-stitches talk. "This is going to hurt." He screamed while I injected marcaine without epi into his chin. He was amazed when it worked. Five stitches, including one corner I was particularly proud of. It should come out neat in the wash. Just a little scar, for the girls.
Little boy throwing sticks when one attacked him. 3-cm lac across the base of the thumb made for tricky anaesthesia, and he screamed even louder. I redid one stitch and added an extra to make it come out neat; the last thing I want to do is limit the child's thumb range of motion. It's always little boys, it seems. Girls do things like step on glass and open restaurant doors across their toes while wearing flip-flops, so I have to pull their toenails off with forceps. And the next day, another stick attack. This time, an older boy, who fell on a stick and got it lodged in his leg. "Why is everyone laughing at me?" Because, O Best Beloved, we laugh at the morbid. Two inches of splinter I did not remove; my staff did it instead.

And the mundane, bread and butter of the ER. Chest pain and abdominal pain and my-prescription-for-narcotics-ran-out-and-I-heard-you-can-get-them-here. One absolute drama queen of a woman who had run out of Tussinex (opiate cough syrup) and albuterol and had an upper respiratory infection. She got albuterol, an antibiotic, and Allegra to treat her symptoms. She was screaming at the secretaries that the doctor wouldn't give her what she wanted and she was going to another emergency room until someone would prescribe "my g-d- Tussinex!" Addict.
A lot of patients who come to the ED because they have no primary doctor. Every ER doctor I work with has a speech about the sad state of primary care and health care in this country, and how family doctors won't make time to see patients any more because they have to meet quota for their HMOs and don't have time for work-ins. Every ER doctor I work with rolls his or her eyes when another patient with NFD (no family doctor) listed under "MD" comes into the ER with symptoms that would normally warrant a quick call to the family physician. Nobody knows how to fix it.

And then there are emergencies. Heart attacks. CODE STROKE scrawled in large letters across the orders section of a chart, a patient whose papers are printing out after she's already down to CT scan. The little girl who fainted for the third time in her five-year lifespan, right onto the glass coffee table. Unresponsive and 80% oxygenation (she died), possible radial artery puncture (false alarm), drug overdose, rape. The short code discussions - "If this doesn't work, the next step is a tube down your throat to help you breathe. Do you want us to do that, if it comes to that?" Assault with a brick. Assault with a fist. Miscarriage. Child swallowed a penny (Mom got it out, baby is fine). Child is lethargic and not responding well (there are rules based on age and appearance, who stays and goes). Although it is rarely used for its named purpose, the emergency room is there, O Best Beloved, for emergencies.
There was one bed occupied in the ER when I arrived at 0715. When I left at 1615, there was one bed empty in the hospital. $major_trauma_center was on diversion, we had chest pain patients in any available room, monitored or not, and there were six charts to be seen and ten more in the waiting room.

Broken ribs and digital blocks and who are you going to call when you wake up in the middle of the night and your stomach hurts so badly you cannot breathe?

now feeling:: sleepy sleepy

12 whispers echo . o O ( ... ) O o . whisper a word
reynardo From: reynardo Date: September 24th, 2004 04:45 am (UTC) (etched in stone)
Every ER doctor I work with has a speech about the sad state of primary care and health care in this country, and how family doctors won't make time to see patients any more because they have to meet quota for their HMOs and don't have time for work-ins.

In Aus, the usual ER care is free. I understand that in the US you have to pay for your treatment there, or sign it in under your insurance. Or have I got that wrong? I used to think it was free like ours which would be why people turned up there instead of paying for their local doctor, but I wasn't aware that the doctors themselves were on quotas.
ayradyss From: ayradyss Date: September 24th, 2004 11:31 am (UTC) (etched in stone)
In the US, you are entitled to a screening medical exam and any stabilizing treatments including care for an unborn child or labor, regardless of your ability to pay.
What that means in reality is that a lot of people do come to the ER and give the wrong name, number, or address. Or they simply don't pay. A lot of ER care is free in the end, not to mention hospital care in general, whether or not it should be. Even I just now got around to paying my family doctor for the co-pay on my insurance for visits back in 2002.
HMO-style insurance oversimplified is big-business doctoring; you have to see a certain number of patients a day, do a certain number of procedures, make a certain amount of money for the group.
attickah From: attickah Date: September 24th, 2004 06:22 am (UTC) (etched in stone)
I've never in my life had a primary doctor. I used to have a primary clinic full of random, roll-of-the-dice doctors that stayed an average of 3 years. I had a dentist I went to every 6 months, growing up. But the concept of a family doctor, with my family, died when we buried my grandfather and his family doctor retired shortly thereafter.

I think the concept is neat and worth looking in to...even as I cringe at the personalization that must come along with it. To me, healthcare that isn't fast-food style would be awkward. A visit involving some sort of friendly relationship with the person seeing my maladies is an utterly foreign concept to me.
ayradyss From: ayradyss Date: September 24th, 2004 11:26 am (UTC) (etched in stone)
There's a huge benefit that comes with having a family doctor - you have someone who knows your past health problems, has a record of what antibiotics, pain medications, and other therapies worked well for you, knows what kind of specialists you've seen in the past, and has some kind of continuity of care over the long term.
The personalization is especially important when it comes to preventative and long-term health care. Your family doctor can keep a record of things like blood pressure, cholesterol, weight, and general state of health - identify trends that can often be treated non-medically, before they become health problems - be someone to turn to with questions about diets/exercise programs/medications/family issues. It's a whole-person style of medicine, very different from the fast-food delectation.
attickah From: attickah Date: September 24th, 2004 12:34 pm (UTC) (etched in stone)
With all of the complications my dad had after his last hip surgery, my parents are starting to find out that having one dedicated doctor to take care of you is really helpful. Even one who just knows your past history and can explain it--with proper terminology--to the rest of the staff taking care of dad is a great boon. All of that information about what had happened to dad was in his file, but what doctor has the time to read a file that's thicker than the Chicago White Pages before they stop by for a routine visit on rounds with a guy that will (in theory) be discharged before they do rounds on that floor again?
ayradyss From: ayradyss Date: September 25th, 2004 02:26 pm (UTC) (etched in stone)
Amen to that.
Dad doing all right?
attickah From: attickah Date: September 26th, 2004 06:05 am (UTC) (etched in stone)
He's doing mostly-alright. Though his other hip (the right, which was supposed to be replaced due to arthritis last summer--until they realized the left was nearly dislocated and needed immediate replacement) still needs replacing and is starting to hurt him enough that they've given him Vicodin for it. And they've warned him several times now that actually going in to get it replaced will like-as-not kill him. He's intending to hold off until at least next spring--at which time, he'll reevaluate whether or not surgery is worth his life. I'm guessing the vote will be yes, with the way he was limping today. Today was not a Good Day for him. They are getting ever-more rare now, the Good Days. Sometimes I wish I still lived at home.
ayradyss From: ayradyss Date: September 26th, 2004 11:21 am (UTC) (etched in stone)
*hugs* You're in my prayers.
waifofthenorth From: waifofthenorth Date: September 26th, 2004 08:46 pm (UTC) (etched in stone)
I guess having a family doctor saved my life, whether i like my family doctor or not...
ayradyss From: ayradyss Date: September 26th, 2004 09:36 pm (UTC) (etched in stone)
Now it's just a matter of finding a family doctor you have a good relationship with :)
turnberryknkn From: turnberryknkn Date: September 24th, 2004 11:43 pm (UTC) (etched in stone)
Once again, as so many times before, thanks for sharing with everyone what few ever see. I think in reading your stories, people come to understand what medicine is like better than ever before...
ayradyss From: ayradyss Date: September 25th, 2004 02:27 pm (UTC) (etched in stone)
Good to hear from you, sounds like you've been terribly busy recently.

And that's my hope.
12 whispers echo . o O ( ... ) O o . whisper a word