Have 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
I 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.
It’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,
“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.
One 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.