Ever have such a crappy shift…

[FlaminHotER]

…that the meth’d out patient is the most reasonable person in the dept?


I legit thought about leaving the department and never looking back.

Today my dept was extra flaming hot. I legit had zero sad feelings about never stepping foot in it again

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[cyanide12345678]

Today it was announced that my critical access ER was shutting down. Fun times. Half the hospital staff laid off. A lot of nurses crying and upset

 

[FlaminHotER]

Today it was announced that my critical access ER was shutting down. Fun times. Half the hospital staff laid off. A lot of nurses crying and upset

I’m sorry to hear that.

I found out yesterday that some of my favorite hospitalists to work with and admit to have been told that their contract won’t be renewed

Guys were solid and we all worked well together on getting patients taken care of.

I really hate medicine sometimes

 

[cyanide12345678]

I’m sorry to hear that.

I found out yesterday that some of my favorite hospitalists to work with and admit to have been told that their contract won’t be renewed

Guys were solid and we all worked well together on getting patients taken care of.

I really hate medicine sometimes

I can’t imagine how tough it must be for some people.

Anyone who thought there will always be smaller places that no one wants to go to needs to realize a lot of them are in the red and hospitals are shutting them down as well. It’s a grim future we are looking at. The hospitals that stand are over crowded, under staffed, and just miserable.

 

[PianoMedic]

I can’t imagine how tough it must be for some people.

Anyone who thought there will always be smaller places that no one wants to go to needs to realize a lot of them are in the red and hospitals are shutting them down as well. It’s a grim future we are looking at. The hospitals that stand are over crowded, under staffed, and just miserable.

…and many dozens of miles from where a lot of people live. People are going to keep driving into the bigger centers, and they’re going to be sicker and sicker. Primary care in those areas is drying up significantly as well. It’s hard to have a profitable primary care clinic on Medicare and Medicaid alone. Problem is, gotta have people out there doing the farming or our food supply becomes much less secure. We need people there, but we also need to be able to get them health care resources. Telemedicine might help with the primary care issue, but obviously doesn’t work in an emergency.

 

[bravotwozero]

Today it was announced that my critical access ER was shutting down. Fun times. Half the hospital staff laid off. A lot of nurses crying and upset

Sorry to hear that. You have prn gigs you can work at for now, or does your cmg have another site they can put you in?

If you wanna come to houston, our group is looking for a nocturnist lol.

 

[Janders]

I did recently have a shift where I said, with complete earnestness, "the elderly lady in 6 who's tripping on LSD is the most reasonable person here"

yes, she was elderly. yes she had bought LSD and used it. No, we didn't know this when she got to us. Yes I was including myself and the rest of the staff in my denominator.

 

[cyanide12345678]

Sorry to hear that. You have prn gigs you can work at for now, or does your cmg have another site they can put you in?

If you wanna come to houston, our group is looking for a nocturnist lol.

Thanks. I’m not with a CMG. The docs are all doing fine and were offered other sites to work at. I already split my hours between 3 sites within the university system and will just be working more at one of the other sites where i already work 4 shifts a month. Now ill be doing 10 shifts a month there. Doesn’t change Anything for me - same employer, same income, same benefits.

 

[psychemdoc]

…and many dozens of miles from where a lot of people live. People are going to keep driving into the bigger centers, and they’re going to be sicker and sicker. Primary care in those areas is drying up significantly as well. It’s hard to have a profitable primary care clinic on Medicare and Medicaid alone. Problem is, gotta have people out there doing the farming or our food supply becomes much less secure. We need people there, but we also need to be able to get them health care resources. Telemedicine might help with the primary care issue, but obviously doesn’t work in an emergency.

Have definitely seen a group of rural fm doctors printing money (almost 7 figs each)but they bill for everything (as they should) and work 60 + hours a week regularly and manage APPs and have multiple clinics. I know this is technically doable and that this is the way that even most specialists make their money with 50+ patients a day but hardly anyone wants to work that much for their whole life. One random day I was talking to one of their nurses who was leaving the clinic around 6:30 she told me they were still seeing patients and it was a 73 pt day for her doctor. Insane volume and super long wait times for the patients. But the alternative is driving 45 minutes to the “big city” and thats not happening. This is primarily Medicaid and Medicare patients in the rural south.

 

[Brigade4Radiant]

Rural areas will continue to decline. The volume isn't there and its moving to larger cities. Younger people are not willing to live more than an 1.5 hous from a decent sized city. Wack food choices and having to drive a ton just to "see the outdoors" Not a lot of options for childcare and wack schools. Even if you make more you must spend more for your house to be similar. Poor cell phone reception and no broadband no thanks.

 

[RoyBasch]

Yes I was including myself and the rest of the staff in my denominator.

 

[Sushirolls]

Rural areas will continue to decline. The volume isn't there and its moving to larger cities. Younger people are not willing to live more than an 1.5 hous from a decent sized city. Wack food choices and having to drive a ton just to "see the outdoors" Not a lot of options for childcare and wack schools. Even if you make more you must spend more for your house to be similar. Poor cell phone reception and no broadband no thanks.

I just moved from Blue State, bigger metro, to flaming Red, and middle of nowhere.

Here I don't have to worry about my kids getting force fed propaganda or urged to change their gender. Here, people still stand for the flag, property rights still mean something.

There are people intentionlaly moving rural.

As far as above one poster decrying woe for those in rural... I don't feel sorry for my community or any others in middle of no where. Its just another political talking point, and people know in rural places you have less resources and access to services. We shouldn't be striving to push for "equality" of rural with urban. If that's what people want, they should move.

Childcare is hard to find rural or urban, but at least here its a little cheaper than previous metro I was at.

Broadband... Starlink solved that problem.

Cell reception... meh... less phone calls is nice.

 

[miacomet]

The worst shifts I've had are where I've had to take care of terribly ill colleagues. The anesthesia attending who needed to be intubated. The tech who had an MI at 45. The colleague who lives in a darker place than you ever imagined. That stuff enters your soul and never leaves.

 

[Birdstrike]

That stuff enters your soul and never leaves.

There are shifts from 20 years ago that still haunt me to this day.

 

[Brigade4Radiant]

I just moved from Blue State, bigger metro, to flaming Red, and middle of nowhere.

Here I don't have to worry about my kids getting force fed propaganda or urged to change their gender. Here, people still stand for the flag, property rights still mean something.

There are people intentionlaly moving rural.

As far as above one poster decrying woe for those in rural... I don't feel sorry for my community or any others in middle of no where. Its just another political talking point, and people know in rural places you have less resources and access to services. We shouldn't be striving to push for "equality" of rural with urban. If that's what people want, they should move.

Childcare is hard to find rural or urban, but at least here its a little cheaper than previous metro I was at.

Broadband... Starlink solved that problem.

Cell reception... meh... less phone calls is nice.

There are red cities and small towns that are red that aren’t “rural” and there are several private religious schools in cities plus at least you get food options.

 

[WilcoWorld]

I did recently have a shift where I said, with complete earnestness, "the elderly lady in 6 who's tripping on LSD is the most reasonable person here"

yes, she was elderly. yes she had bought LSD and used it. No, we didn't know this when she got to us. Yes I was including myself and the rest of the staff in my denominator.

Bad trip, I presume?

 

[MechEDoc]

Today it was announced that my critical access ER was shutting down. Fun times. Half the hospital staff laid off. A lot of nurses crying and upset

Is that a good thing or a bad thing? Sometimes closing isn't such a bad thing, sometimes it is.

 

[CoolDoc1729]

Rural areas will continue to decline. The volume isn't there and its moving to larger cities. Younger people are not willing to live more than an 1.5 hous from a decent sized city. Wack food choices and having to drive a ton just to "see the outdoors" Not a lot of options for childcare and wack schools. Even if you make more you must spend more for your house to be similar. Poor cell phone reception and no broadband no thanks.

It’s always a choice, right? I live fairly rural although near highways and close enough to stores, library, schools etc. I’m 20 minutes from the nearest hospital and perhaps someday that will be a problem .. but it’s a nice community with good schools where I literally don’t lock my doors. Phone reception mandates we have to choose Verizon, there are worse things though.

If not enough people choose to live somewhere for whatever reasons, then the local economy will collapse and everyone will move somewhere else. I don’t think there’s a perfect place to live.

 

[thegenius]

…that the meth’d out patient is the most reasonable person in the dept?


I legit thought about leaving the department and never looking back.

Today my dept was extra flaming hot. I legit had zero sad feelings about never stepping foot in it again

Yea I had a couple this last week. At one point my average age was 86 across 8 patients. With a min age of 79. Another point I just had so many patients who “can no longer be cared for at home.”

This, intermixed with the total benign stuff and I was just exhausted. I didn’t have a single real case (wait it did, bad old asthma/COPD who also had a new pleural effusion and lung mass.).

Nothing I’ve written is unique. I just spent 20 minutes talking to a colleague about how the current health care model is crumbling with all the baby boomers now turning 75-100 and our system can’t take care of them. They don’t need there ER, OR, OP clinics. Most need group homes situations and doctors at assisted living, and all be on palliative care. Again…there isn’t much we can do.

 

[CajunMedic]

Yea I had a couple this last week. At one point my average age was 86 across 8 patients. With a min age of 79. Another point I just had so many patients who “can no longer be cared for at home.”

This, intermixed with the total benign stuff and is was just exhausted. I didn’t have a single real case (wait it did, bad old asthma/COPD who also had a new pleural effusion and lung mass.).

Nothing I’ve written is unique. I just spent 20 minutes talking to a colleague about how the current health care model is crumbling with all the baby boomers now turning 75-100 and our system can’t take care of them. They don’t need there ER, OR, OP clinics. Most need group homes situations and doctors at assisted living, and all be on palliative care. Again…there isn’t much we can do.

Sounds like my patient population. One night, one whole side of the department was octogenarian belly pains, N/V/D. I swear to god, they can be some of the most helpless people with zero common sense and ability to take pepto-bismol, imodium, milk of magnesia, etc. Worst part was the nicest one, wound up being the sickest and when they finally got CT'd, got a helicopter out for gastric wall pneumatosis and air in the portal vein.

Few shifts ago, had a 39 year-old with a terrible dissection. Onset at 1800, arrival at 1827, CT complete around 1850, accepted to CT surgeon at tertiary center and helicopter launched at 1900. Seized, intubated around 1930, coded 1938, pronounced 1959. Failed emergent pericardiocentesis.

Rural areas will continue to decline. The volume isn't there and its moving to larger cities. Younger people are not willing to live more than an 1.5 hous from a decent sized city. Wack food choices and having to drive a ton just to "see the outdoors" Not a lot of options for childcare and wack schools. Even if you make more you must spend more for your house to be similar. Poor cell phone reception and no broadband no thanks.

There are times I miss my place in rural Louisiana. But, I don't miss the DSL we had until we moved to WV, or the hour drive for food and shopping. My commute to work is 10 minutes in the suburbs, We've got plenty of restaurants, and I can be at Costco in 30 mins. I really thought I wanted to work at Podunk General Hospital, Airport, Hair Care, Tire center and Crawfish Hut, but the headaches of licensing, credentialing, and travel expenses for the ridiculously low pay aren't worth it.

 

[Apollyon]

The worst shifts I've had are where I've had to take care of terribly ill colleagues. The anesthesia attending who needed to be intubated. The tech who had an MI at 45. The colleague who lives in a darker place than you ever imagined. That stuff enters your soul and never leaves.

There are shifts from 20 years ago that still haunt me to this day.

I recall one study that said 17% of EM docs fit the criteria for PTSD. I am seeing PTSD soldiers every day. What is the hallmark? Flashbacks. And that's what y'all are mentioning.

Don't sit on it. It's bad stuff. A stat they drilled into us is "Every day in the US, 120 people kill themselves. 20 are soldiers. 17 use a gun." I think I got away relatively unscathed, because I don't have the flashbacks.

 

[The Knife & Gun Club]

I walked out of my last shift of residency 2 days ago, flaming dumpster fire of a day with patients screaming at me, nurses screaming at me, CT tech screaming at me, admin screaming at me, all over things I can’t control because the system is too broken to care for people who have 0 ability to care for themselves.

Look dude I’m sorry you pulled out your picc line and signed out AMA yesterday with a septic prosthetic hip but got home and couldn’t care for yourself and $hit in your armchair. But yes if you want to be re-admitted I do need to put a new IV in you. Oh you’d like to sign out AMA again? Sure. Don’t have a ride home and no one will come pick you up? Ok. Daughter calls - yells at me - he’s not welcome back home because he keeps pooping himself. Screaming “NURSE” at the top of his lungs over and over again so someone can wheel him outside to smoke a cigarette. Multiply that times infinity for 12 hours.

Active chest pain that cardiology refuses to see again cuz he’s still doing cocaine at 68. Hospitalist won’t admit because “what are we going to do for him anyway, cardiology made their recs.”

Code a guy. Go tell the wife and daughter he’s gone. Didn’t have the heart to tell them he was found in a hotel room with a hooker and pile of meth.

Had a cool case of wide irregular tachycardia with a rate of 170. That was fun.

Admin is upset at me, calling q20 minutes, because I’ve had someone up for admission for 8 hours but the admitting NP won’t place orders because they’re “too busy on the floor.”

Went over to the badge office and picked up my new ID for Anesthesia/Critical Care fellowship.

I used to love EM but the social strain is just too much.

Hopefully it will be better. If not that, at least more linear.

 

[GassYous]

Didn’t have the heart to tell them he was found in a hotel room with a hooker and pile of meth.

That's how I'd like to go

 

[RustedFox]

I walked out of my last shift of residency 2 days ago, flaming dumpster fire of a day with patients screaming at me, nurses screaming at me, CT tech screaming at me, admin screaming at me, all over things I can’t control because the system is too broken to care for people who have 0 ability to care for themselves.

Look dude I’m sorry you pulled out your picc line and signed out AMA yesterday with a septic prosthetic hip but got home and couldn’t care for yourself and $hit in your armchair. But yes if you want to be re-admitted I do need to put a new IV in you. Oh you’d like to sign out AMA again? Sure. Don’t have a ride home and no one will come pick you up? Ok. Daughter calls - yells at me - he’s not welcome back home because he keeps pooping himself. Screaming “NURSE” at the top of his lungs over and over again so someone can wheel him outside to smoke a cigarette. Multiply that times infinity for 12 hours.

Active chest pain that cardiology refuses to see again cuz he’s still doing cocaine at 68. Hospitalist won’t admit because “what are we going to do for him anyway, cardiology made their recs.”

Code a guy. Go tell the wife and daughter he’s gone. Didn’t have the heart to tell them he was found in a hotel room with a hooker and pile of meth.

Had a cool case of wide irregular tachycardia with a rate of 170. That was fun.

Admin is upset at me, calling q20 minutes, because I’ve had someone up for admission for 8 hours but the admitting NP won’t place orders because they’re “too busy on the floor.”

Went over to the badge office and picked up my new ID for Anesthesia/Critical Care fellowship.

I used to love EM but the social strain is just too much.

Hopefully it will be better. If not that, at least more linear.

America.

 

[GonnaBeADoc2222]

I walked out of my last shift of residency 2 days ago, flaming dumpster fire of a day with patients screaming at me, nurses screaming at me, CT tech screaming at me, admin screaming at me, all over things I can’t control because the system is too broken to care for people who have 0 ability to care for themselves.

Look dude I’m sorry you pulled out your picc line and signed out AMA yesterday with a septic prosthetic hip but got home and couldn’t care for yourself and $hit in your armchair. But yes if you want to be re-admitted I do need to put a new IV in you. Oh you’d like to sign out AMA again? Sure. Don’t have a ride home and no one will come pick you up? Ok. Daughter calls - yells at me - he’s not welcome back home because he keeps pooping himself. Screaming “NURSE” at the top of his lungs over and over again so someone can wheel him outside to smoke a cigarette. Multiply that times infinity for 12 hours.

Active chest pain that cardiology refuses to see again cuz he’s still doing cocaine at 68. Hospitalist won’t admit because “what are we going to do for him anyway, cardiology made their recs.”

Code a guy. Go tell the wife and daughter he’s gone. Didn’t have the heart to tell them he was found in a hotel room with a hooker and pile of meth.

Had a cool case of wide irregular tachycardia with a rate of 170. That was fun.

Admin is upset at me, calling q20 minutes, because I’ve had someone up for admission for 8 hours but the admitting NP won’t place orders because they’re “too busy on the floor.”

Went over to the badge office and picked up my new ID for Anesthesia/Critical Care fellowship.

I used to love EM but the social strain is just too much.

Hopefully it will be better. If not that, at least more linear.

For case #1, I usually walk out of room, hang up on family, go take 20 min coffee break.

You didn't work and train the way you did to deal w that. Also, it's not your problem to solve.

Nolite te bastardes carborundorum

 

[The Knife & Gun Club]

That's how I'd like to go

I think you’re confusing “hooker and pile of meth” with “stripper and pile of cocaine”.

 

[thegenius]

I think you’re confusing “hooker and pile of meth” with “stripper and pile of cocaine”.

As long as the F occurs...and then you go. Nothing would be worse than hitting the meth and you croak before even having a good time.

 

[Janders]

Bad trip, I presume?

Actually, didn't seem that bad of a trip.

Issue was no one knew she took a metric-****-tonne of LSD (IIRC sober alcoholic x 10yr, sober opiate x 5 year), and family found her super-altered, non-verbal... EMS found her tachycardic, diaphoretic and odd. STROKE CODE! ?SEPSIS ALERT?

My impression after 30sec was "nurse, I think she's... tripping. I think its some type of upper mixed with hallucinations... maybe some meth and GHB? *shrugs* lets get all the labs and a head CT". Our spider senses can be great, and also... what a commentary on our lives that I can watch a bizarre, altered elderly lady for a few seconds and pretty much win a game of guess-the-pathology...

Anyway, she cooled off after the first hour, and was just smiling and describing the beautiful flowers she saw blooming on the walls of the ER room. I still maintain at that moment she was the most reasonable person in the department.

 

[Janders]

The worst shifts I've had are where I've had to take care of terribly ill colleagues. The anesthesia attending who needed to be intubated. The tech who had an MI at 45. The colleague who lives in a darker place than you ever imagined. That stuff enters your soul and never leaves.

YEP.
Ill colleagues. and normal younger types who come in talking and die despite your efforts.
My flashbacks involve either my colleagues, or people in their 30s who I spoke to and then they died; especially if pregnancy was involved.

 

[WilcoWorld]

Went over to the badge office and picked up my new ID for Anesthesia/Critical Care fellowship.

So, you're staying at the same place?

 

[WilcoWorld]

Actually, didn't seem that bad of a trip.

Issue was no one knew she took a metric-****-tonne of LSD (IIRC sober alcoholic x 10yr, sober opiate x 5 year), and family found her super-altered, non-verbal... EMS found her tachycardic, diaphoretic and odd. STROKE CODE! ?SEPSIS ALERT?

My impression after 30sec was "nurse, I think she's... tripping. I think its some type of upper mixed with hallucinations... maybe some meth and GHB? *shrugs* lets get all the labs and a head CT". Our spider senses can be great, and also... what a commentary on our lives that I can watch a bizarre, altered elderly lady for a few seconds and pretty much win a game of guess-the-pathology...

Anyway, she cooled off after the first hour, and was just smiling and describing the beautiful flowers she saw blooming on the walls of the ER room. I still maintain at that moment she was the most reasonable person in the department.

Some say you might go crazy
But then again, it might make you go sane

 

[The Knife & Gun Club]

So, you're staying at the same place?

Yup. Just moving over the ICU. Same system but ICU is far far more functional and well resourced

 

[WorkNoteEmergency]

I walked out of my last shift of residency 2 days ago, flaming dumpster fire of a day with patients screaming at me, nurses screaming at me, CT tech screaming at me, admin screaming at me, all over things I can’t control because the system is too broken to care for people who have 0 ability to care for themselves.

Look dude I’m sorry you pulled out your picc line and signed out AMA yesterday with a septic prosthetic hip but got home and couldn’t care for yourself and $hit in your armchair. But yes if you want to be re-admitted I do need to put a new IV in you. Oh you’d like to sign out AMA again? Sure. Don’t have a ride home and no one will come pick you up? Ok. Daughter calls - yells at me - he’s not welcome back home because he keeps pooping himself. Screaming “NURSE” at the top of his lungs over and over again so someone can wheel him outside to smoke a cigarette. Multiply that times infinity for 12 hours.

Active chest pain that cardiology refuses to see again cuz he’s still doing cocaine at 68. Hospitalist won’t admit because “what are we going to do for him anyway, cardiology made their recs.”

Code a guy. Go tell the wife and daughter he’s gone. Didn’t have the heart to tell them he was found in a hotel room with a hooker and pile of meth.

Had a cool case of wide irregular tachycardia with a rate of 170. That was fun.

Admin is upset at me, calling q20 minutes, because I’ve had someone up for admission for 8 hours but the admitting NP won’t place orders because they’re “too busy on the floor.”

Went over to the badge office and picked up my new ID for Anesthesia/Critical Care fellowship.

I used to love EM but the social strain is just too much.

Hopefully it will be better. If not that, at least more linear.

Meanwhile, over in the C-suite, while soft music is playing, they're looking at powerpoint and congratulating the cardiologists on their wonderful metrics and complaining about the ER wait times.

 

[Birdstrike]

Meanwhile, over in the C-suite, while soft music is playing, they're looking at powerpoint and congratulating the cardiologists on their wonderful metrics and complaining about the ER wait times.

…final meeting topic, “Does Our Mission Statement Meet Today’s Needs?”