You might have noticed that there is a new headshot accompanying my column this month. Times change – I’ve swapped the Navy cap for a suit a some gray hairs – while some things stay the same. I’m still working the night shift and my wife still rolls her eyes at me at least twice a day.
Everyone agrees that we need to lower the cost of healthcare. After all it represents upwards of 17% of GDP with some sectors still rising. But that’s about where the agreement ends. Immediately we begin to fight over what is making costs rise and what to do about it.
As I walked into the room and gave a tired smile and introduction, I saw the mother of the small baby girl start to relax. “Yes, I believe you are right. She probably has croup,” I said after listening to the mother’s history while watching, then listening to the child breathe.
“I’m sorry but the image of a naked baby flying around shooting an arrow into the heart of someone just doesn’t really make me want to fall in love,” I said. It was Valentine’s Day and we had just been seated at Cafe’ Normandie, our favorite French restaurant.
The night was bitter cold but so windless that if you stood still only your nose and finger tips felt it. The dry snow crunched and squealed as the ambulance drivers turned their wheels to back onto the bay to drop off the two patients inside. It was Christmas Eve and the only people working that night were those who got the short straw. But they were trying to make the best of it.
Have you ever asked a patient a question only to have them mumble into the blanket or to the wall so softly that you couldn’t understand a word they said? Or worse, I’ve had patients, for whatever reason – anger at the wait, a show of control – refuse to answer my questions or say anything at all. “I don’t care if you only have a few minutes with me,” they seem to say. “Don’t bother me, I’m napping.”
It had been a quiet, peaceful summer afternoon and I wasn’t really looking forward to the chaos that I knew was waiting for me in the ED. Two ambulances were empty with their doors still standing ajar and two more were parked in the parking lot when I arrived. I stopped for one last moment to look out over the harbor before entering the ambulance doors. I took a deep breath and plunged into the department like a fresh substitute in a football game.
The two women sat quietly in a corner of the busy ED, almost lost in the business of people being shuffled off to get labs and x-rays. The elderly woman sat with her head bowed in prayer or pain while the younger woman looked anxiously at her. Even though the chief complaint was “chest pain” she had been brought in her daughter’s private vehicle instead of an ambulance.
I picked up the first chart of the night and read the chief complaint. “Suicidal.” You never know what that means. It could be an old man who has sat all day with his shotgun in his mouth and finally thought better of the situation. It could be a belligerent drunk who was thrown out of his house by his wife and knows that he can stay in the hospital over night if he claims he is going to kill himself.
One of the things I like the most about the ER is that it is the real “No Spin Zone”. More accurately, it’s the “No BS Zone”. The dynamics are straight forward. It’s just me and the patient. He’s sick and I’m there to help. It doesn’t matter if he smells like moldy gym socks or if he’s completely broke. It doesn’t matter if he likes me, and it certainly doesn’t matter if I like him.