A Budding Emergencist
Wednesday, August 02, 2006
  Doctor Nirvana

Ahh, I'm there.

Doctor Nirvana.

Cheerfully and expertly spouting nearly-useless facts while taking 6 hours to clean a miniscule big toe lac and close it with Steri Strips. Why did it take so long, do you ask?

Because I have to ask permission to wipe my ass.

Okay, I've bundled up two lacs in a row (because I must fill in THE CREDENTIALLING LOG with lacs and pelvics and nose tamponades and arterial punctures and foley catheterizations) and while the first one is dealt with (it takes twice as long to do the paperwork as it does to care for the patient--by the end of the year I hope to be spending only the same amount of time doing paperwork as doing patient care (one of the reasons why I like EM is that a progress note can consist of "Surgery admitted the patient, then the CT came back normal, then surgery signed off; discharge (ahh, the triple parenthetical. Now I've reached blogging, or as I prefer to call it blooging, nirvana))) the second lies down on the gurney, and I clean off his lac with gushes and high-pressure streams of saline (the solution to pollution is dilution), while discoursing learnedly on how hydrogen peroxide is useless as a wound cleaner, because all it does is react with the peroxidase in RBC's, killing them and releasing O2, while simultaneously lysing clots, which knit a wound together, but is marvelous as a cleaner of old dried blood. Ahh, tis a fine line between a run-on sentence and a complex predicate with several dependent clause, and the semicolon is your best friend. Doo-be-doo-wah! Yeah! Yeah! Yeah!

And the patient lies there(dang, can't start a sentence with a conjunction! Damage control!), with his 18 year old muscle bound brother who's going to law school, even though he's 18 and must only just be entering college, with a "Trust me I'm a lawyer" t-shirt, in a marvelous (oops, can't use the same adjective twice in such proximity, try the thesaurus--ahh, exemplary display of inner-city irony and po-mo-ism, as I regale him with medical minutiae, gently and with laughter, not tears, steering him away from the camp of the sodomites; I find a fairly superficial scratch that managed to penetrate his calluses. Problem? A scratch. Solution? Go home, weenie! Oh, no. Not so fast, buster. First you must clear it with the ATTENDING. Because it's their ass with the malpractice insurance, and my ass that will be chewed if I maange a patient without their holding my hand, because after all, I'm just an intern, and really know just about zip about anything. But before all of this happened, CHIEF RESIDENT had to come in and demonstrate the REGIONAL NERVE BLOCK, which, I have to admit, was kind of cool, (how long can this paragraph go on? Keep reading and find out!) however useless (as the pt went home with steri-strips, and not sutures, cf. above), and the SECOND YEAR RESIDENT (i.e. REAL resident, as opposed to me, a FAKE resident, because while it says RESIDENT on my badge, I'm really just an INTERN, and therefore, know knothing and must. have. hand. held.) comes in and inquires about the undermined CALLUS on said big toe which is sure to come off at some point in the future, when the wound may require RE-EVALUATION by yet some other, higher authority in the hierarchy, to ensure cosmesis (great word, used almost exclusively in ER, for "a good cosmetic result," meaning, dem wound edges, dey be apposed, and yet miraculously NOT UNDER TENSION! by the surgical ties, i.e. sutures, that bind them), when the ATTENDING finally, later comes in, takes one look, and says--hmm. superficial. Wound edges apposed. d/c. ON KEFLEX (a powerful antibiotic used for COMPLICATED! skin infections (which this decidedly was not, being a SCRATCH), and OH GOD! OHMIGOD DID YOU MAKE SURE HE HAS TETANUS PROPHYLAXIS? Did you ask five times? Did you give it anyway?

That's why it took six hours to treat a scrach under some poor schlub's big toe.
 
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Emergency medicine, from the beginning of a new doctor's career.

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Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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