Have you ever arrived at the hospital for your shift with the sinking
feeling that the odds were stacked against you? Sometimes it’s a quick
look at the ambulances lined up waiting to drop off patients. If I walk
by the waiting room I can sometimes get the feeling of whether people
are waiting patiently or whether there is a sense of anger and
I came up the companionway of our boat, ready to take over the night
watch from my daughter who was standing alone at the helm. “I see that
the wind has freshened,” I said cheerily. This a term sailors use when
it’s blowing like crazy.
Working the night after a holiday is always a bummer, especially
Thanksgiving. I usually eat so much turkey, dressing, mashed potatoes,
and pumpkin pie that I start to resemble the unfortunate bird himself. But my wife always drags out the Christmas decorations to
get a head start on the next season. Every other year I’m spared from
this duty as it is my turn to traipse off to the hospital for another
shift. Thankfully, it’s usually quiet. I guess most people are laying
around stuffed like I was. But a few make it in to the ED with the usual
“If the Republicans win big they plan to choke off health care reform,”
said my wife while reading the morning paper. “That’s what you want,
isn’t it?” She’d heard me rant about the long-term negative effects that
the recently passed bill would have, and I think she was hoping this
election cycle might put an end to it.
When the phone rang at 4:30 in the morning, instead of sleepily reaching
for the bedside phone, my wife literally jumped out of the bed. With an
elderly parent, she is always worried that such late night calls mean
bad news. I, on the other hand, have a more sanguine view of life, and
try to avoid any such thoughts that might interrupt a good night’s
As a Navy reservist assigned to a Marine Corps unit, my annual training
requirement – AKA “summer camp” – usually meant going with my Shock
Trauma Platoon to some foreign country to stand by while a Marine rifle
company carried out a live fire exercise with the military from the host
It was a hot Saturday night and the ED was packed, as usual. All the
histories seemed the same: “I was sittin’ on the stoop drinkin’ a few
cool ones . . . then he said . . . then I said . . .” Countless cuts,
bruises, and possible blow out fractures filled every room.
I believe that the answer to defensive medicine and the damage it has done to our health care system lies in our own hands. We are the ones who establish the ‘standard of care,’ beneath which is negligence.
“Hey Doc, where’d you get that costume?” Andrew asked after he
instinctively jumped to his feet upon my entering the kitchen. As a
midshipman at the Naval Academy he is trained to be respectful, but I
guess the ‘costume’ sort of took him by surprise. He and a friend from
the academy had just arrived for a visit to our house for the weekend.
This month Night Shift changes gears, publishing a post from one of our favorite medical blogs,
I walked into Room 17 to see a sixty-ish woman who, by the nurse’s
triage note, had come to our ER for shortness of breath. A smoker, with
a history of chronic obstructive pulmonary disease (COPD). The nurse’s
note reflected her suspicions that this patient may have pneumonia.