Otitis media (n.) – inner ear infection
STEMI (n.) – ST elevation myocardial infarction. A heart attack which presents initially with elevation of the ST segment in one or more leads on an EKG. Warrants prompt transfer to facility with cath lab availability
Sepsis (n.) – systemic infection involving the blood, stemming usually from an underlying infection, e.g. pneumonia
Track marks (n.) – either healing puncture wounds (fresh) or healed punctures that have bruised or scarred, resulting from intravenous drug use
In the past year and a half, I have found that there are certain moments that I have experienced in the emergency room that stand out in my mind. Theoretically, if I’ve spent eighteen months working forty hours per week, I would have spent around 2,800 hours in the ED, and if, on average, I’d seen two patients per hour, that would mean that in the course of my time in the ED I have seen 3,600 individual patients, each with unique complaints. As such, it seems as if these experiences blur together, leaving a uniform memory of simply being in the ED and seeing people. No faces, no names, and a plethora of various complaints, from cuts to scrapes to bruises to STEMIs. It is because of this that when a new highlight is etched into my mind, I often consider why my brain has allowed it to be so. It’s not a matter of whether this is significant, but WHY is it significant. Some are obvious. The nicest people you’ve met. The sickest people you’ve met. The most impressive radiology you’ve seen. Others are a bit more complicated.
Night shifts in the ED are generally hit or miss in regards to volume and severity. Some nights will see six people total. Others will see over thirty. Some nights are laceration nights. Others are GI bleeding nights. For scribes at this particular facility, we arrive at 6 PM and leave at 1 AM. Generally, most prefer to just work a double shift to avoid travelling for seven hours of work. On this particular night, the acuity of complaints had been surprisingly high. By the last hour of the shift, we had already seen two STEMIs and a septic elderly gentleman who, sad as it is to say, probably did not survive to see the next week. This was fairly uncommon. For every ten patients, you may see one critical patient, and yet three had stumbled into our facility seeking refuge and cure. There’s a saying that I’m particularly fond of in this regard. “They’re in the right place. We can help them.” Truer words have never been spoken. However, on this particular night, none of these cases caught my attention. Instead, they provide context, buildup to the patient encounter that provides me the ability to recollect this particular night.
From 12 AM to 1 AM, to me, is like the witching hour. It is generally ill advised to assume that because there are no patients there will be no patients coming in, or that there won’t be some unfortunate soul that has found themselves within the grasp of death at approximately 12:50 AM. It seems a good time to fall ill for whatever reason. On this night, this was not the case.
Ten year old male complaining of sore throat, fever, and ear pain. Mundane to say the least but a medical complaint nonetheless. He’s in the right place. We can help him. Strep and a flu, antibiotics if necessary. Follow up with your doctor in two or three days. Easy peasy. Flu negative. Strep positive, plus an otitis media. Antibiotics it is. So, as the physician is talking with this child and his mother about antibiotic use and following up with their PCP, I’m left to gaze around the room and wait until this conversation is over. It was during this gaze that one aspect of this situation caught my attention. This child’s mother, about thirty years old if I had to guess, was standing in the corner of the room, and sprinkled from the bottom of her rolled up sleeves were track marks. Probably seven or eight per arm. At that moment, a kid with a sore throat was etched into my mind more than heart attacks, more than septic patients. Why?
It seems odd that something as serious as a heart attack or sepsis would become “ordinary”, but in the course of work in the ER, these things are not uncommon, and as I mentioned, most of them just blend together. This particular case, for whatever reason, threw a wrench into the normal function of the ER. Like I said, “they’re in the right place. We can help them” is a saying that generally holds true. The ER is equipped to handle most any ailment under the sun, and if we can’t fix it, we’ll send you somewhere that can. The moment that I became aware that this child’s mother may have been on drugs, that saying was no longer true. Once he left our facility, I couldn’t help him. The sad reality of his situation hit me like a ton of bricks. I had no guarantee that he would have his mother through high school, or not find her dead from overdose at age ten. I quickly realized that what brought him to the emergency room posed a far lesser threat than what he would return to upon leaving. And worse, that I was powerless to help. Of course, in my current position as a scribe that is generally the case. But even after I finish my training and become whatever type of physician I decide to be, there is still nothing I can do to ensure his well being apart from writing his antibiotics. What an odd feeling.