Wednesday, January 12, 2011

Follow Up


So in my previous posts one of the cases I talked about was an aortic dissection. I have done some fun stuff lately at work, but this case I am very proud about (and I really didn't do much).

Aortic dissection are not common. When you do find one, it is usually too late and the patient dies. This patient was relatively young (40s), and did not have the classic symptoms of a dissection. The only reason I looked for it was because he had a new murmur. I very easily could have not gotten the cat scan (almost didn't), and he would have died.

So when I found it, I was thinking this guy might actually survive this b/c we caught it early. When I called the thoracic surgeon at midnight, he did not share my enthusiasm. He was PISSED b/c he had a big day scheduled and did not want to be operating.

He even asked if I could transfer him to another hospital! Of course I said NO I am sure other hospitals thoracic surgeons have big days planned as well.

So after yelling at me for finding this dissecting aorta in a young man, he was forced to take him to the OR. He huffed and puffed and said what a waste of time this guy is going to die.

Guess what....less than a week later, the guy went home today. He WALKED OUT of the hospital and should be fine.

Great save indeed, despite grumpy f***ing surgeons.

-ER Doc

19 comments:

Krista said...

Hopefully the pt gives credit where credit is due. Great save.

Anonymous said...

Good catch! Your patient is lucky - my aunt had one blowing out on her, and they cracked her chest right there in the ER.

RehabNurse said...

You rock ER Doc! I hope I get someone like you when some moody surgeon doesn't want to get out of bed to save me!

Melissa said...

Dude, you rock. That's really all I can say about that. :)

SerenityNowHospital said...

I appreciate the nice words. I wasn't sharing the story for personal credit. I could have just as easy not scanned the guy and it turn out the other way. Just lucky. The patient doesn't get it. I am sure the surgeon is the hero to him. And rightfully so. Thats gotta be a tough thing to repair. To the patient, I did my job. He wasn't medical savy so I dont expect him to understand the luck we had with him.

ER is a thankless job. Thats fine. I just didn't expect that from the consultant. I am used to it from hospitalists and general surgeons, but wasn't expecting it from a thoracic surgeon in a rare case with a young person that he could save. oh well

Sarah said...

Here's an idea Mr. Surgeon- don't schedule a heavy day the morning after you are on call! : )

Faking Patience said...

I transported a patient with a AAA to the trauma center from our little ER... they barely looked at us when we got there, made us wait quite a while for a bed, and then put her in the hallway. Makes you wonder about some of the hospitals...

Shash said...

Let's hope the consultant is just grumpy when he wakes up. In the long run, he's probably a good guy. Or so I hope.

Anonymous said...

Sarah,

The surgeon could schedule a light day the night after being on-call. Of course oftentimes one is not all that busy when on-call and oftentimes those unassigned admissions from the ER don't ever pay. So in exchange for working for no pay, you want him to decrease his paying work the next day. Not really in his best interest. If he is on-call 1 night in 5 you just decreased his income by 30-40%. It is more than 20% cut because overhead is minimal at the margin.

SerenityNowHospital said...

Sorry that's BS. Specialists are paid good money to be on call. Thousands of dollars a night when they usually do nothing. Basically sleep pay. They are on call for these kind of emergencies, so if they are needed, you need not o worry about their damn wallet.

ER Doc

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Anonymous said...

Really, specialists get paid for being on call in every hospital in America? Really?
Oh wait, not really.
And internists and FPs don't get paid for doing unassigned call at many hospitals that don't have hospitalists. Those DT patients with sepsis take a while to admit and stabalize and don't pay.

Anonymous said...

Yes absolutely they get paid. No one can force them to take call. And internist and FPs are not specialists. If they are on unassigned call and not getting paid, then they are doing it in order to keep privelages at that hospital

Anonymous said...

I guess someone should tell the specialists at the last hospital I had privelages at. Because most of them weren't paid for call. Taking unassigned call was part of having privleges. As you already stated, it was a requirement of priveleges.
Of course they are not required to take call. They can not have priveleges and not take call. Of course then they don't have a GI suite/cath room/OR/etc. unless they own/join a private one. And then they cannot keep the patients overnight in the overwhelming majority of those so they just have the easy cases. And some doctors actually want to be doctors.

Anonymous said...

And you are apparently OK with the lowest paid doctors(internists/FPs) not getting paid for unassigned call but subspecialists should? Internists/FPs probably admit more patients any given day than all the specialists combined at most community hospitals. I can guarantee that is true at my hospital by not mere numbers but factors.

Anonymous said...

no but thats the way it is. and the hospitalists need the admits for b/c thats what they do for a living. the specialists dont need what they get on call. and i think its fucking ridiculous the money they get paid for being on call

James Connolly said...

Just saying, if all you Annons could use a name, even if its fake, it would really help tell who is saying what and give some understanding to your point of view.

Angelina said...

Is is safe to say that it is 90% skill and 10% intuition? If so, I'm glad you listened to your intuition in this case.

Great save!

ERP said...

I hate about 1/3 of surgeons but about 90% Neurosurgeons and CT surgeons. $$$$$ and an easy call is their primary goal in life. FU would say to that guy and threaten documenting something to the effect of "Dr Dickbag concerned about his morning OR schedule and thus not recommending emergent surgery for dissection".