A Budding Emergencist
Friday, August 18, 2006
  VIPs are not immune to medical dehumanization
I had mistakenly picked up a VIP, after my attending told me to pick up "Lauren Barkerson" (Sigh. After all the trouble I take to camouflage my identity, location, and hopsital, still you doubt.) I instead picked up Leroy Schneerson, and spent a goodly time poring over his previous visits and the triage note. Triage notes a 72 year old with a 1.5 week history of GI bleeding. PMHx: s/p colonoscopy today AM (it was about 7:45 P.M.), 'tics, CAD, high chol, DM2, yadda yadda yadda. After ordering triage labs that were conspicuously absent, 'specially type and screen, EKG, CXR, "ER Belly labs," (CBC, Chem 7, Amyl, Lip, Pt/Ptt, Liver profile, and, mysteriously enough, Lipid profile (yeah, like we're gonna start statins on a single, sick, unknown fasting state lipid profile.)) and "ER CP labs (Most of the above plus trops, "CKAxsymb" and myoglobin.) (yeah, no ESR or CRP. whatever.) Then I look up to eyeball the patient. Uh. Looks like I'm walking on eggshells for awhile. The salty patient representative (very helpful to have) comes up and says, "You gotta go see this guy. He's a bigshot local judge, a VIP". As I go over to see him, I get an overhead page for a phone call. Huh? I din't page any one. Did I? NVM. "Dr. Emergencist here." "This is Dr. Important. I did the colonoscopy this morning." "Oh, okay. Well, he's slightly hypotensive, and I've got a note from the PMD Dr. Influence saying he's dropped his crit from 35 to 23 in a week. He's a little hypotensive (104/56) but he looks AAOx3." "Okay, document his guiac and get a [6 hour GI bleed nuclear scan]". "...okay...what's that?" (I'm deciding he know's I'm a tern, and play it to the hilt.) "It localizes GI bleeding as little as 0.1 ml." I'm thinking, wow, sounds cool, but, gee, don't think my attending will go for it. "sure thing, Dr. Important. Soon as I evaluate him." The patient had been in the ER for 1.5 hours after triage by now. So I go to see him, when my attending says, "hey you din't pick up that patient I asked you to." "umm, yes I did. Leroy Schneerson. VIP--GI Dr. Important called ME!" "No, go see the original patient I wanted you to see first. She's been waiting 2 hours" Hmm. I look at VIP, primed to evaluate him and finesse the situation--no such luck. About face back to the tracking board. This one is 79 and "generalized weakness". Crap. Oh, and a h/o neurofibromatosis and afib. ? Uh, okay, I'm sure there's something perfectly obvious and slam-dunk for me, so I can get to VIP. I don't want administrators, irate private attendings, and belligerent relatives breathing down my neck as I go see a different patient. So I'm juggling diagnosis and management of two complicated elderly patients, something a
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Emergency medicine, from the beginning of a new doctor's career.

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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