altHave you ever gotten a chance to see how one of your ‘one in a million’ cases turned out? You know, the gunshot to the chest that got opened in the ED and actually lived? In emergency medicine, unless you work in an academic center doing research, most of our cases are lost to any long term follow up. But that doesn’t keep us from wondering just how things turned out.

altI don’t often get calls from thoracic surgeons asking for my help. But this was a unique circumstance. His son, a first year student at the U.S. Naval Academy (a plebe as we call them) was going through his first baptism by fire. He was concerned that his son was hitting a breaking point, so he reached out for my help.

altIt’s a simple question. Given a specific set of facts concerning the presentation of a patient in the ED, what would the reasonably prudent physician do? Or stated more specifically, was an emergency physician’s actions in response to a given set of facts reasonable? This is the “standard of care” against which the physician’s actions will be judged in a case of alleged negligence.

As I arrived to work I saw that the parking lot and the waiting room were packed. This is not supposed to happen at this place. “I’m getting too old for this,” I mumbled to myself as I dropped my 2am lunch in the frig and grabbed a handful of charts. I’d raced through an hour of charts before it dawned on me that they were filling the rack as fast as I could empty it.

Barry, the senior paramedic, was at the head of the gurney as they wheeled into the trauma bay of our ER. “This guy shot himself,” Barry said. “It’s a mess.” One of the other paramedics pumped on the guy’s chest while a firefighter fumbled to undo the yellow straps securing him to their gurney.

With less access to primary care and multiple gatekeepers adding to the expense of health care, perhaps EPs should be the final stop for many ED patients.

Last spring a group of physicians and medical societies filed suit in federal court to overturn a state law that bans healthcare professionals from asking patients about whether they own a gun. On first blush, it seems like the reasonable and responsible thing to do. The government has no place in telling doctors what they may or may not ask a patient, right? Maybe.

“Did you know that sleep walking will get you disqualified from the Navy?” I asked my wife in response to her usual “What did you do today?” interrogatory. It was drill weekend and I had just finished one of my rare day shifts serving at the Naval Academy clinic.

Over the years I’ve gotten many calls like this one. “Will you look at this case? Something very bad happened and I think someone screwed up.” They seldom say it quite that bluntly, but that’s what they mean.

altOne day, many years ago, I was sitting in front of the television when an emergency news bulletin broke in. There was a major water leak on Broadway and 34th Street in New York City, not far from where our family lived. The camera faded to a big hole in the street with water gushing out of it. There was the usual crew of nine men looking idly on, but in the hole, there was one man digging frantically. His head bobbed up and down, shovels of mud flew through the air.

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