Wednesday, September 8, 2010

Come On Guys

At busy high acuity hospitals, the Emergency Department can become very overwhealmed. The constant beating gets to everyone, and stress levels rise quickly. I admit, sometimes during pointless codes you hope that chronically ill patients with no quality of life will not get a pulse back. We all think it. Less work, less resources, time to decompress the ED, etc. But a couple of responses from colleagues really took me back today, especially b/c the patients were not GOMERS.

1- A 64 year old male came in combative and confused. End diagnosis was hypertensive encephalopathy. I had to intubate him and put him on a couple of different drips to control his BP. I called the hospitalist to admit him and told him the story. His response, "64 years old...damn too old for Medicaid and too young for Medicare."

WTF?! Come on man. I guess I just forget that some docs think about the insurance first off. As ER docs, we have to see them all and treat them the same regardless of insurance.

2- This one really got to me. 50 year old female brought in full CardioPulmonaryArrest. She did have a cardiac history, but still was young. EMS coded her for 10 minutes before arrival. I intubated her, started a central line, and continued the code. After 12 minutes (22 minutes total CPR), the charge nurse came in the room and said, "Hey, she has been down over 20 minutes now. Why don't you just call it b/c it will be much easier if she dies than if you get her back."

WTF?! Hell no. If she was 90, yes I probably would have called it. Not at 50. 2 minutes later the patient had return of spontaneous circulation. Instead of being happy, the charge nurse was upset b/c now there was more work to be done. Yes the department was chaotic, but the patient was get over it.

She is now in the ICU, weaning off pressors, over-breathing the vent, and has NO signs of anoxic brain injury.

....BTW these were my FIRST 2 patients of my shift yesterday (Tuesday afternoon). They came in within 15 minutes of eachother. Lots of critical care today. The day after a holiday is never good.

-ER Doc


ERP said...

I always prepare emotionally for the inevitable bending over and grabbing ankle that occurs the day after a holiday.
Good work getting the lady back regardless...

Eponine said...

Easier if she dies?!

That really worries me. I hope that's not the general consensus with hospital staff.

I am very glad that you continued and saved her. I hope my life is in your hands one day instead of that nurse's.

Pissed Off Patient said...

The first one, I don't take too cynically. My mom has said as much herself(she was laid off and is currently working in the Caribbean teaching English because no one will hire her at her age but she's 6 years from SS and medicare.)

The second, wow. Scary. I wish we did a better job of supporting care providers so they didn't burn out quite so badly.


tracy said...

i soo respect you, ER Doc...thank you.
The attitudes you encountered were deplorable.

Shash said...

Thanks for your work ER doc. As I just hit the 50 mark over the weekend, I'm glad someone wouldn't list me as "too old to survive."

arzt4empfaenger said...

Keep going, you can do it. Also, wtf... that charge nurse should go somewhere else instead of making everyone's work unpleasant.

med464 said...

Wow the charge nurse seems to be burnt out and needs to find a new job. because the min. it is more about what I will have to do then about a pt's life is when I am going to have to find a new career path. sad though. good job staying on top of everything despite the neg. atmosphere.

June Cleaver said...

"WTF?! Hell no. If she was 90, yes I probably would have called it. Not at 50."

Thank you.

My dad died a month after his 50th birthday. He was an alcoholic and, of course, had liver disease. He was a good man, worked hard, supported his family...but I felt his doctors basically wrote him off. I wonder if, had they treated him a bit more aggressively, would he still be alive? (he did quit drinking as soon as he was diagnosed)

Not only did you give that woman the chance she needed, but likely saved a family a lot of heartache and "what if's". So, thank you again for nto giving up on her when someone else wanted to.

Crazed Nitwit said...

Okay I just need to say this: YOU ROCK!!!!!!!!!!!

How do you deal with the stress that comes with your job?

Rob @ online lpn program  said...

I hate it when I hear nursing staff and even doctors saying that it will be easier for a patient to die so that he/she will not have to do more after. I sometimes do feel their sentiments because, when one is tired, one prefers to get it over with. Kindness will only hurt you more, especially if you are in the ER, and you see these accidents cause by being negligent and reckless with their life. You want to end their life because it is kinder, and you want to prolong the agony of the person who is the cause of the accident. I sometimes think of taking up online lpn program to shift to being an LPN rather than a doctor, I am still thinking about it.