mark-plasterSometimes you end up working a holiday because you are too lazy to check the calendar. Believe it or not that’s just how I ended up working on my last birthday. Thank goodness it wasn’t my wife’s birthday. But when I entered the ER last night and saw all the hearts hanging on the walls, I realized I’d blown it again.

mark-plasterIt was my turn to work New Year’s Eve and I was hoping against hope that bad weather, the down economy and fate in general would combine to make it a slow night. I would have settled for even a slow start to the night. But it was not to be. The jammed parking lot was my first clue and it was cause for a deep preparatory sigh and an additional squirt of stomach acid as I trudged through the ambulance doors.

mark-plaster“Hmmm,” I said, half snorting, half sighing as I scanned my email in-box. “It looks like now every insurance policy is going to have to cover psych admissions.”

I’m proud of the fact that I’m self sufficient in the emergency department. And it irritates the fire out of me to see prima donnas (read surgeons) come into the department and require the entire staff to follow them around to do little things they could do for themselves. I guess you could say that I was trained well by a charge nurse by the name of Beatrix where I did my residency.

Something had just happened that I didn’t understand. A man had stared death in the face and winked. But more than that, the life he had exuded, even in the moment of dying, seemed to still  be present. His son was different. I was different. More alive. More human.

I love it when the lecturers say the same thing: “Take a good history…” They act as if we don’t know what questions to ask. Don’t they get it? The right questions are written on the template. But sometimes I just didn’t know what to do with what the patient told me. Let me give you an example

altAs I entered the room my eyes went immediately to the elderly lady sitting halfway off the chair beside the bed. She appearing as if she was about to slip off onto the floor at any moment. I introduced myself and reached out to shake her hand, but her hands were occupied gripping the seat in an attempt to support her weight while lifting her hip off the chair.

alt“Can we pleeease feed that little girl in room two,” the nurse pleaded. “Her mother is driving me craaazy asking if she can go down to the vending machines and get something. I think she needs to smoke and needs an excuse to leave the baby with the dad. All she has is a bladder infection.”

alt“Hey sweetheart,” I said, interrupting my wife’s thoughts as she concentrated on writing her blog. “How would you rate me? You know, as a husband.”

altIt had been a long day when I sat down by the roaring fire to enjoy a glass of red wine. My father-in-law, who lives with us now, sat down nearby and began to describe his worsening, but stable angina. While attempting to pay close attention to his story I began to notice something strange that I initially mistook for the effects of the wine.

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