Ambulance ≠ Free Pass to the Front of the Line

No matter what you think, coming to the ED in an ambulance does not mean that you get to STAY in the ED and not go outside to register and wait your turn.

The ambulance is not a taxi.

The ambulance is not a free pass.

Just because you picked up the phone and called 911 and they came and got you and they brought you to the ED does not mean that you are having an emergency.

Who decides if you're having an emergency? That's right. ME.

Just because you were here two days ago for your 99-degree fever and slight cough does not mean that you get to be ahead of all the people with 101 fevers and coughs who have been waiting three hours to be seen. You're no sicker now than you were then.

Lying down on the floor (EW! do you KNOW what has been on the floor before you lay there?) is NOT going to get you my sympathy. In fact, what it will get is a doctor hovering over you, telling you to get up, you're fine, and then two security guards to escort you to the waiting room.

My Butt-Clenching Moment

So there was this really sick dude, right? All intubated up and stuff? And he's like on pressors and jazz? And he's like lying there in the bed. And then he starts throwing frequent big ol' PVCs. And then a few runs of V-tach. So I mosey on over there and put the defibrillator pads on him--just in case. He seems fine for a few minutes, and I go back to my seat.

The ICU doc covering this patient calls me and says, "Can you start a magnesium drip on this guy? His magnesium is really low." So I start the drip, but am running it a little slow, because his pressure is pretty low and I don't want to drop it too bad. I'm sitting back at the desk and I happen to glance over at the monitor and what to my wondering eyes should appear:


I LEAP up, run to the bedside, yelling for a little assistance, check and--no pulse. Then, without even thinking about it, I charge the defibrillator and shock the guy. It was like my hand just flew out there and did it by itself. By the time one of the docs got to me, the guy was back in NSR. The doc said, "Well, looks like you've got this under control. Good job!"

And then I sucked in a big breath because I realized I hadn't been breathing for a little bit there, and then I turned up the magnesium drip a little.

The swine flu is kicking my ass

No, I don't HAVE the swine flu. But dealing with all the people who think they do is really getting on my nerves.

We had a very well-publicized death from the swine flu in our area recently (THANKS MEDIA!!), and yesterday had a huge upswing in visits from people "who need to get checked out."

I've had to explain eight gazillion times that:

-We don't swab for ANY flu if the patient is not sick enough to be hospitalized.
-If you don't have any symptoms, we can't "check you" for the flu.
-A slight cough, low-grade fever, and some body aches is not enough to get you hospitalized if you are a generally healthy person.

PLEASE TAKE OFF THE FREAKING MASKS ALREADY IF YOU ARE NOT SICK!!!! What I especially love is all the people walking around with the masks slung around their necks. The whole hospital looks like our surgery floor. Oh, and PLEASE stop asking for gloves. Just go wash your hands or use some hand sanitizer.

The most amusing episode in all of this was last night. The "asthma" area was full of wheezing people, thanks to our record-high pollen levels and fluctuating weather patterns. Two young women sit next to each other: an African-American girl and a white, Eastern European girl. The African-American girl is wheezing, coughing, feverish, has an obvious runny nose and looks unwell. The Eastern European girl has a low-grade fever with slight abdominal pain and vomited once.

One of my least favorite doctors swooped in and moved the Eastern European girl off to a bed, complete with mask on "because this might be the real deal." Uh huh. On further investigation, the African-American girl? Lives at the epicenter of all of the swine flu madness, and everyone in her family is sick. If you ask me, THIS lady is the one in contention for "the real deal." I found a spot for her to lie down and gave her a mask. She got admitted, and the swab was pending when I left to go home last night.

I can't shake my feeling that the doc moved the Eastern European patient to a bed because she bore a strong resemblance to his wife.

Another study in contrasts

I just don't understand why people don't medicate their kids. Your two-year-old has a 105 fever? For two days? What, no Tylenol or Motrin? Oh, I see, you were waiting to see what we say is OK to give to your kid. No call to the pediatrician, huh? Oh, ok. What's that? Your four-year-old fell down and hurt his arm two days ago? And it still hurts? Did you give any Motrin? Oh, I see--you brought him in last night, but you had to wait more than a half hour, so you changed your mind? Ok, so you brought the poor kid home and dragged him back here this morning and HE IS IN PAIN AND YOU NEVER MEDICATED HIM???

Contrast this to the woman who came in with dental pain after an extraction who has been taking SIX tylenol. Every TWO HOURS. Around the CLOCK. FOR THE LAST TWO DAYS. Oh, and now your stomach really hurts? I bet it does.

Ma'am, you now have much worse problems than your dental pain.

And in THIS corner...

Seems like I've been fighting with patients a lot lately, and getting my butt kicked by little old men and women.

I have some lovely deep scratches on my right forearm from an elderly woman who really didn't want me to draw her blood.

And I have two (count 'em) hand injuries resulting in swelling, both from little old dudes who didn't like me much. One took my right hand in a gentle, caressing way and then proceeded to look me in the eye and twist my index and middle fingers so hard that both proximal knuckles popped and swelled up significantly. The other old dude grabbed my left thumb as I was trying to clean the poop off his hands and bent it all the way back, laughing maniacally. I'm very grateful that his family was not there at the time, as I yelled, "OW! You FUCKER!" at him. It was the end of the night and I was tired of getting beat up.

Also I caught my psych patient (with a blood glucose of 600) squeezing her urostomy bag so hard it squirted piss all over the curtain and floor in a lovely golden fountain. When asked why she was doing it, she said, "No one brought me a sandwich!!" I asked her if she had requested a sandwich. "No, but NO ONE BROUGHT ME ONE AND I AM HUNGRY!!!" So apparently my mind-reading abilities are off, as well.

How to Get Swine Flu