(Just a few random questions from real readers-PB)
What is your job really like?
As you know, I am an Emergency Physician working in a medium-sized community Emergency Department in a medium-sized hospital in a medium-sized city in a medium-sized state. A “community” Emergency Department is not a major trauma center and generally sees mostly medical complaints as opposed to the big urban Emergency Departments that see mostly medical complaints with a varying amount of stabbings, shootings, and other acute medical problems that are the inevitable sequelae of Standing On the Corner Minding Your Own Business.
My hospital was purpose-built a few years ago to sit astride the major nursing home trade routes and commands this commerce for many miles around. There are twenty or thirty nursing homes of varying quality within a quick ambulance ride of the place and, as you can imagine, a large percentage of our patients are the warehoused elderly who present with a varying quality of complaints ranging from the sublimely ridiculous (Altered Mental Status in a demented, contracted 92-year-old who hasn’t moved in two years except when indifferently rolled and slopped by the surly hired hands) to the legitimately dire (septic shock in an otherwise healthy elderly lady).
We also get the usual general medical complaints, most of them incredibly minor, most of which barely rise to the threshold of needing medical care at all much less both barrels of the Medical Safety Net. We address ’em all however although in my role of community educator I do counsel people on the appropriate and inappropriate use of Emergency Medical Services. I understand that some patients don’t have doctors but a rather large percentage of my patients have doctors and either didn’t want to wait for an appointment or were too lazy and irresponsible, despite having insurance, to inconvenience themselves in the slightest to schedule one.
Eczema, for example, no matter how itchy, is never a medical emergency and don’t expect me to apologize for making you wait five hours to be seen. And standing at the door to your room glaring at me while I work on your fellow citizens who are actually sicker than you won’t make me see you any quicker although I admire both your stamina and your absolute commitment to not walking across the street and getting some skin lotion from Wal Mart, an enterprise that would have taken you ten minutes and was helpfully suggested by the triage nurse.
And for the one thousandth time, fever in an otherwise healthy toddler is not an Emergency either. It’s 3 AM, for Christ’s sake, and you will pardon my incredulity as I look at your playful, active, rambunctious child stuffing Cheetos in his mouth. Oh, and just because we didn’t order any lab work or imaging doesn’t mean we “didn’t do anything.” From start to finish you had some high-powered talent working on you. Your nurse has a college degree and years of experience and assesed you child perfectly in triage. I have a ridicuous amount of training and education and if between your nurse and me we decide that your kid ain’t that sick he probably ain’t that sick. Did you notice the thoroughness of my physical exam? I’m not just pretending to look in his ears, you know. Surely the history and the exam are “something.”
The major difference between this job and many other typical jobs is the pace. I saw 42 patients in twelve hours last night and never stopped working for the whole time. Emergency Physicians don’t get breaks per se. We are usually scrambling to keep things moving and when things get a little slow we try to catch up on our charting, a task made extremely difficult in my particular hospital by The Worst Emergency Medical Record System In The Entire Universe, a little nightmare called Medhost that apparently got its start as a restaurant order and billing system and has not progressed much from there.
But I digress.
We try to keep people moving in and out, either admitted or discharged, but inevitably something comes up and people start waiting for disposition. Part of this is my fault as I am still learning how things work in a real Emergency Department where the process of evaluating, treating, and dispositioning is substantially different than it is in the academic world. On the other hand a couple of critically ill patients or an inexplicable run of ambulances can back up the department for hours, distracting us from our true mission of treating your child’s ear infection at 2AM because your appointment with his pediatrician in ten hours was just not soon enough.
I enjoy my job even if I am glad to leave when my shift is over. It’s not really too stressful. The most aggravating thing about it are the long stretches where every patient seems to be “Otherwise well child, active, playful, with a low-grade fever.” The critical and otherwise actually sick patients are a relief.
What do You Think About Ted Kennedy?
Don’t get me started. First of all, I will never understand the fawning adulation lavished on our corrupt hereditary ruling class by the press. Mr. Kennedy was a voracious parasite on the nation whose appetite for power was only checked by his inability to keep his head in a crisis and his utter unwillingness to dive into the cold waters of Chappaquiddick to even attempt a rescue one of The Little People, a throwaway citizen who was just a hired mourner in the long dirge of the Kennedy odyssey. Mr. Kennedy never held a real job as far as I can tell, never produced any useful good or service, and lead an entirely privileged life out of which he felt comfortable pontificating to the rest of us about Good Citizenship, Duty, Honor, and what constitutes a good life in our now completely insane nation. He was a senator for as long as I have been alive and the web of corruption and influence peddling he spun is the best argument I can think of for term limits.
But isn’t that the problem with American politics; that it is full of people who have done nothing and know nothing about anything but politics and yet feel confident and, what’s worse, divinely entitled to solve complicated problems that are well out of their scope of experience? That’s why President Obama is such a failure and going down like your prom date: Having been sheltered in academia and government for his entire adult life, he doesn’t know anything about the real world, not even enough to know what he doesn’t know.
So sing your paeans and bow your heads. Wax sanctimonious about the passing of your paper mache great men. I don’t mourn the passing of tyrants.