Separate names with a comma.
Discussion in 'Emergency Medicine' started by docB, Oct 12, 2004.
Not worth it. Never mind.
I always thank my consultants for calling me back. I never apologize for waking them up. It's your job to be on call, which should have been something that a physician who takes call understood when they applied for residency. I think it's important to be professional and courteous to our consultants, but we do not need to be apologetic for our consultations. Please elaborate on what your expectations are from the Emergency Department, if you would not mind.
See, that's what I'm talking about. Whenever I say to an ER guy "why are you complaining about the people who use the ER as a primary care facility? You knew what you signed up for when you applied for residency," nobody goes "ooo, you're right! I'll never speak of it again." Why is that? The point is that you just say "who cares that you're on call? You're supposed to be. And as for me, well, I'm not. Isn't that great?"
To me, any time I have to bother anyone for any reason at night, I feel bad and, yeah, I am apologetic. You're trying to intimidate people into feeling bad for being apologetic like "you want me to apologize???" Yeah, I do. Sorry I'm not like you and just say "who cares that I'm waking someone up? I don't care. Who cares? Not me." The reason you don't care is you'll never experience it. I can guarantee that if I woke you up a few times at 2 AM when you were at home, you'd wouldn't be happy about it. And, in fact, it bothered you to such a large extent that chances are that it placed at least some role in your career pathway decision making process. So for you to act like it's no big deal is unbelievable.
Leave this thread alone and go back to the one you started about how miserable your life is. I'm sorry you don't have a girlfriend, or many friends at all for that matter. It isn't like when you get consulted you have to leave your family. I remember XBox having a pause button.
So basically your rebuttal is a personal attack? That's great, you sure are smart.
You base your arguments off of a seemingly personal vendetta against the specialty - or rather those who aren't upset about their life choices. You sure are "smart" as well.
Lol, what vendetta is that? All I said was that any decent person would have a sense of compassion for waking people up in the middle of sleep or pulling them away from their family at random moments, especially if you based your own decision on a specialty on that. I never said "you can't choose shift work." I said that people who do choose it and then act like anyone who didn't "deserves" call is a douche. I also stand by all those statements. I'm also intrigued by your inability to see what I wrote.
Not a doctor, but... I'd feel awful calling someone in the middle of the night and not saying, "Hey, sorry to bother you, but...".
But that's just me, and hey, not a doctor.
It's not about what they say, to be honest. There's no good resolution to the problem because there's no way to reconcile the discrepancy between the way the two professions are organized. When someone doing shift-work -- and it could be an ER guy or it could be a hospitalist or anyone -- calls someone on call, to be honest, they're just like these guys on here. After maybe one day, they're like "hey, it's part of the job, so whatever" and they stop caring or thinking about the person on the other end of the line, other than if that person is irritable to them and then they say "well, clearly he's an a-hole because I don't know why anyone would be irritated at 2 AM or be upset that they're missing their son's recital." It's human nature and understandable on some level that they'd stop caring. They can't care about that stuff. But what it engenders is this attitude that you see on here where it's like "you chose a job that's not shift-work, so cry somewhere else. But not to me, I'm going off shift." It's literally going from "I don't care" to "not only do I not care, but I revel in the fact that I don't have to take call and you do, you're a chump, eat it." There are lots of phone calls that don't need to be made at 1 AM that are because of that lack of concern.
People get inured after a while, and when you combine that with the stress levels that doctors have, I can understand where some of that hostility might come from... I'd like to think I'd do better, but I probably wouldn't.
Wow. That's just a whole other level of assholery, really.
It's basically not even that. It's that they don't even stop and think about it. They just tell their clerk to make the page and then briskly say "thanks for calling back ..." and then tell you something where, about two seconds in, you both realize that the call didn't need to be made at that time. But if you say anything, then suddenly there's this ten minute lecture on "this is my job to let you know about this stuff and blah blah blah." They're technically right if you want to go by the strict letter of the law, but they're really not.
Ah, OK. I see. That makes a bit more sense, and seems a lot less dingus-y.
I know that's not actually a word, but it should be!
This story isn't about lacking empathy for a colleague, this is about lacking empathy for an dingus. No one has any empathy for anyone who uses the unique hardships of their chosen career as an excuse to do their job badly. Not for the Pediatrician who excuses his incompetence with low pay. Not for the ER doctor who says he doesn't have time to be polite and see 2.5 PPH. Not for the nurse who is so unhappy at having taken a subordinate position in the hospital that he spends the day watching Netflix rather than watching his patients. And not the on call surgeon who doesn't have the decency to speak to the family a 40 y/o DOA stroke patient because its just so hard to take home call.
Everyone here empathizes with everyone elses hardships and we do our best to help work around them. Most people do try not to place stupid consults at 2 a.m. and most people are even understanding when an on call surgeon in more irritable on the phone than he probably should be. If this guy had been barky and snappish at just the ED attending this story probably wouldn't have involved him. But it was more than that: he fought back against a reasonable indicated consult and then couldn't be bothered to speak to the family before storming out of the ED. The second you decide that your job is so hard that you don't need to do it correctly the empathy ends.
But you seem to think that by criticizing that guy's response to the surgeon, I'm defending the surgeon. I'm not. They're BOTH in the wrong.
Start a new thread to complain. Don't keep harping in this one - unless your continuing gripe IS that "medicine sucks", because you're not a night owl.
Don't worry about ruralsurg, he was one of the trolls leading the charge against EM as a medical specialty on the Allo thread a couple weeks back. Not sure why he is chiming in here now...
I actually only elaborated because I was asked to. But actually my current gripe is that "medicine sucks because of the attitudes of some of our peers." Does that satisfy your requirements?
That is a rather contentious tone. I don't have any requirements, and demand nothing of you or others. Instead of perseverating, as I said above, start a new thread. Or don't. Whatever you choose.
It's not contentious. Your earlier post did make a demand and did have a requirement. So I was merely asking if my subsequent response met that requirement.
This will all get moved to the 'discussions' thread in a little bit anyway.
I have mad respect for my physician counterparts in other specialties who can be on call in the middle of the night. Not all of us have this screw you because you ain't like me attitude.
As an aside to everyone who is always bashing IM residents; I am an ER resident and a medicine resident was the one who taught me to do a line better than my senior.
On top of this had to tell people they have cancer two nights in a row.
I've heard some other folks talk about how often they give the cancer Dx in the ED. It seems I'm running into more of these as well.
Tonight I had a 24 yo with h/o asthma come in SOB. He said it's been getting worse over the past 3 weeks, which strikes me as a little odd. Further, is that he is only wheezing on the right side. He said his neck feels really tight and he looks plethoric. I looked at the portable CXR and he has a huge mediastinal mass. The trachea is compressed to a few millimeters below the thoracic inlet. He's maintaining sats well, but I call anesthesia to come take a look b/c I'm anticipating very difficult airway management. Gas takes one look at the xray and tells me he wouldn't be comfortable trying to manage the airway as it is even in the OR. Doesn't think awake fiberoptic would be able to make it. Says he'll probably need fem-fem ECMO to even try any intervention.
CT shows a 3mm crescent shaped airway that corkscrews to the left and then posteriorly around a 13cm mediastinal mass. I called CT surgery and all he said was, "Well ****, this looks bad." I kept going with the racemic epi nebs and they managed to keep him doing well. Gave steroids and Onc says it's likely a Hodgkins or other lymphoma, but he's seen germ cell tumors do this rarely. I had to call the parents and tell them to come back from Florida RFN.
I have empathy when you get called in away from your family I really do. But that doesn't give you the right to be a dick about it and bitch and moan to the people who called you in. You choose your profession. Do your job.
Things we can (hopefully) all agree on:
1) There are many aspects of being a doctor that suck, regardless of specialty (point of thread).
2) If you're waking up the on-call doc in the middle of the night, you should acknowledge that it's inconvenient/annoying and thank them for their time.
3) If you're the on-call doc, you should do your job without pitching a fit. This includes dealing with calls you don't think need to be made- remember, we don't know your specialty as well as you do.
Am I missing anything here?
The attitude on this forum is not primarily that people that take call are chumps (many of us have significant others that carry a pager). But the problem is that for every physician to physician phone call I place that is not a hospital mandated call, I'm calling because I need to convey information about a patient and in most cases receive some sort of information back. If a consultant's sleepiness or surliness prevents that from happening, my patient's health is at risk and I can't tolerate that.
Many hugs and much respect to you folks who made this thread available and shared your stories. Just had to get this one off my chest.
Having some Western medical knowledge when you live Third World also sucks. Among other things, it means you can explain--in four different languages--that "Yes, this baby is going to die, too," and why the prognosis is less than 2 weeks.
Partner had to have The Talk with a Very Nice young couple (oh, ****) who had just delivered their third baby with spina way-too-much bifida. Bright, cheerful newborn boy who looked otherwise healthy from the front...For bonus suck we had to discuss birth control/prenatal prep options for the next pregnancy (which the parents were understandably gunshy about allowing to occur).
Not really EM, and I apologize for bringing up a dead thread, but I've never really had a place to share before.
I've been a firefighter since I was 15 yo (my department has a junior firefighter program). When I was 17 we got dispatched at 4 am for a structure on fire. We arrive and it's a mobile home. By the time we make scene it's long been on the ground. Still being a junior, I'm not allowed within 50 feet of the fire, so I perch on top of the brush truck making sure it's stocked with foam. The smoke smells different than I'm used to. Then I look over and see the first body. 6 kids, my age at the time, had died in the fire. They had had a party the night before and someone fell asleep with a lit cigarette.
One of the mothers showed up on the scene, she'd seen about a fire on the news. She saw her sons car in the driveway and started screaming for him. It's been 3 1/2 years (I'm 21 now) since the fire and I still wake up most nights hearing her screams. That was the worst call I've been on in 6 years of service.
I don't know how you guys can handle the horrors you see every day. I'm not a religious person, after everything I've seen happen, but bless you all for what you do. After the fire I became extremely protective over the people I love, and it's cost me dearly in the past few years. I didn't deal with it how I should have, I dealt with all my problems in truly horrible ways, but I'm still here. I don't know how you do what you do, but bless you.
I'm not a medical person, but may I suggest therapy? It sounds like you need to talk to a qualified person to help you assimilate this horrible thing you witnessed. *all of the hugs*
I know that smell:
Thanks for sharing. Medicine sucks.
This isn't a dead thread - it only gets bumped when one of us has a painful story to add. I think it's a rather useful thread, and one unlike I've seen anywhere else. But I wouldn't want it stickied... just let it sink back down until someone needs it. It's a rather memorable one.
It's the "PTS-ED-D" thread; that is Post Traumatic Stress Emergency Department Disorder. Lawyers and accountants don't need to have a thread like this, but doctors, nurses, cops and soldiers do. Half of my posts could easily be put here, as many of them are written only because they're still haunting me after years.
Had a middle-ages guy who came into the ED for a general checkup because he had just gotten Obamacare and had some nagging problems he hadn't gotten checked out because of not having insurance for the last 5 years. A string of abnormal imaging studies (abnl CXR leads to abnl CT) shows metastatic cancer. He took it well (family hx of Ca, 100+ pack year hx having quit when he met his wife) but broke down over telling his wife. I told her with him in the room what we knew at that point (unknown primary, not curable). When she understood, she looked into his eyes and he just said "I'm sorry". F$&* cancer.
You got that right - eff cancer, right in the eye!
I had one of those New Year's Day... insurance kicked in that day, so he'd waited about 6 weeks with "gallbladder pain" knowing that he'd have insurance soon and could get it taken care of.
Palpating his RUQ was my first tipoff that sadly, this wasn't just his gb.
That his liver was completely riddled with mets, probably colon primary, was heartbreaking. Even worse was that he didn't have any criteria for admission, no primary doctor, nada. So I wrote him a script for some pain pills, and a referral to a couple local clinics and he went home. We talked at length actually, but he figured he'd rather go home that day and let it sink in. I plugged him into every resource we had, but we're only talking weeks at that point.
I think he knew that it wasn't just his gb, but he kept up a strong face for his wife. His results and the call from the radiologist asking if there was a known primary came back shortly after his wife she stepped out to go grab something to eat. He asked me to tell her, so he wouldn't have to.
Had a bad one a couple days ago - Fever, SOB, Cough - CXR shows a 12x15 cm lung mass w/ satellite lesions.
31 y/o Non-Smoker.
Get help. Find a shrink that does EMDR. I Dont know how it works, but it did.
Sorry for the late edit. After posting I wasn't sure if that experience was appropriate for this forum, so I erred on the side of caution.
I tried that. I missed the debriefing as I had to leave the scene early to go to work while they were mopping up. It's a volunteer department and I had to be at work at noon, they didn't get back to the station until 6. I've seen a couple shrinks since then but nothing's really helped. Maybe I'm just not cut out for this line of work.
As a physician, an Emergency Physician in particular, at least you've got a shot at helping some of the tragically I'll and injured people we see or take care of. That seems to insulate from much of what might otherwise be haunting: a sense that being there, giving it your best, and trying the heroics gave a person one last chance. The ones that seem to be the most haunting are the ones where you feel helpless, more like an unneeded observer of some horrendous tragedy. Those should be the ones that have the least impact as our presence makes little difference on way or the other. Yet it's that exact helplessness that seems to be the most haunting. Like the DOA peds blunt trauma. Knowing, as you go through the motions and are performing nothing but an act, delaying the inevitable notification to the family their loved one is dead and there's nothing you can do. You feel as the ultimate failure. Years of training, schooling, 30 hour shifts, years in practice and you're totally powerless. You're walking down the hallway to meet a family for the first time, only to deliver the most awful, shocking, haunting and heartbreaking news of their life. And you just met them. It makes you want to run away and just not do it. It gives me chills just thinking about it, and it's been years. I can still remember the colors, smell the smells, the sounds.
I'm sorry for sharing that, again.
*all of the hugs for you, my friend*
Last night we had a rollover. One brought in coding,one with serious pelvic fractures and multiple other injuries,one not too bad (pulmonary contusions,fractures of T4-6,concussed,clavicle and rib fractures). Turns out the code who died in our trauma bay while I stuck chest tubes into the pelvic fracture/pulmonary contusion/bilateral haemothorax-was the husband of the least injured person. They were out celebrating his all clear from lymphoma with a family friend. They all decided to celebrate by drunk driving without seatbelts out to visit another friend and rolled the vehicle. Now one is dead (46 year old man) one will likely never walk again and will go to jail for vehicular homicide while under the influence if he lives, and one is widowed. The daughter completely lost it when we told her-she knew right away what had happened. We had to lock down the trauma bay as she went hunting for the driver so she could kill him for what he had done. I should have known that any day that started with a coding 55 year old,previously healthy,wasn't going to get any better.
I am not talking about a CISM debriefing (Mitchell model debriefing of the crew). There is conflicting evidence that this helps, although I believe it does (effectively replacing sitting down at the bar with a few beverages with some old salts and crying in your beer about your crappy shift).
I am talking about seeing a psychiatrist/psychologist who specializes in PTSD and who performs EMDR (Eye Movement Desensitization and Reprocessing). I don't understand how it works (and I don't think anyone does), but it DOES work to reduce the symptoms of PTSD.
Med2UCC - Damn.......
I absolutely swear by EMDR. My therapist used it with me when I was going through a personal issue. Also no idea how or why it works....but I walked out of my final therapy session after effortlessly reforming a crippling anxiety inducing image into one of strength and power. When we were done, all I could think was, "how the heck did that just happen."
Sorry, but that rather large breast mass (the one the RN doing the 12 lead noticed) right where the chest pain that brought you in today that you've been ignoring for the past 4 months is cancer... that's already spread to your vertebrae. However you don't have a PE.
I know it doesn't compare to most in this thread... but it's the first time I've had to personally be the one to break bad news.
Been a while since I've seen this thread, but I had a pretty bad one today. We'll see how it turns out.
Mom leaves 11 month old with a family member while she takes dad to work. Apparently older step sibling accidentally drops unlabeled bag of meds on the floor. Family member tells sibling to pick them up but doesn't really check. Meds in the unsecured bag: clonidine to help him sleep with his crap ton of ADD meds. No one says anything until mom finds baby poorly responsive 2-3 hours later.
Baby comes in hypotonic with shallow respirations. Walk back 30 minutes prior to end of shift. Initially some response to narcan so hope that it may have only been a small amount. 15 minutes later kid tanks, starts seizing, gets intubated, sedated, etc. Ativan, Phenobarb. All the while mom is screaming and crying in the background (appropriately given the situation, but had to be escorted out). Managed to get the seizures stopped and BP stable and packaged to airlift to nearest university hospital. All the while (similar to a previous comment) envisioning my 15 month old through the whole process.
I need to vent. Buddy of mine, 47 M, longtime smoker. Goes to his PCP (who works out of a major city hospital) in August because he's coughing up blood. Gets sent home, told "don't worry about it, it's normal". It stops for a bit. Starts again and his GF notices it. Sends him back to the doctor who does a Chest X-ray. Predictably, there's a mass. Sends him to see an ENT resident who basically tells him he's going to die. GF (who works for SNF/Rehab) throws a wobbly and gets him an appointment at a different hospital. First hospital doesn't send over his records. X-ray, labs, and CT scan later, oncologist says "we're doing a biopsy next week". Biopsy comes back. Oncologist calls: surgery in 2 days. By this time it's mid-February. They pull out a 2 lb pulmonary sarcomatoid tumor. Rare. So rare, they're sending slides to cancer centers in Europe, Japan, Australia and the rest of the US.
Next up: Chemo. Which kicks his ass. Monday, 4 days after his final chemo, he calls me as I'm on my way home from work. Can I take him to the ER, he's having difficulty breathing and the oncology team want him to get an ultrasound and CT scan. I head over to his place, drive him to the ER, and hang out with him while they do ultrasounds and labs and CT scans. The verdict: pulmonary embolus in the lower lobe of the same (right) lung as the tumor, plus more clots in his right arm and leg. They keep him overnight, then kick him out with an Rx from Lovonox. He's got a followup tomorrow where they're hoping to plan radiation therapy.
I want to go postal on the idiot who didn't even bother to get a chest X-ray in August and the ENT resident who told him there was nothing they could do. Because if they'd caught this thing six months earlier, he'd probably have a better chance. As it is, I don't think he's going to be around long.
Say what? I thought one of the goals of Obamacare was to offer subsidized health insurance so people could seek health services in a traditional setting like doctor's offices, clinics, etc so costs of ED's tending to non-emergencies would be eliminated/decreased. Sad story but it also speaks to the failure of one of Obamacare's PR ( to taxpayers) objectives.