The ER and the Night Shift

Its Thursday, about 5 pm or so, and I just woke up. I’ve done 2 shifts in the ED (“ED” is Emergency Department, not Erectile Dysfunction, and is used interchangeably with “ER”). My body feels odd.

So far the ER is not too bad. The first shift was pretty busy (an afternoon shift from 3 pm to midnight), and we kept moving. Last night, though, I worked from 11 pm to 8 am this morning and it was pretty dead most of the night, which is fine with me. I spent about 2 hours trying to do a spinal tap on an absolutely humongous woman – the staff doctor finally got the tap using about a 7-inch needle. (That’s not a typo). This poor woman, who needed a spinal tap (or lumbar puncture) to rule out meningitis, was not in a happy place as we continually tried to find her spinal column, jabbing away incessantly with the ridiculously oversized needle. We did our best to numb everything up but in the end she was just a big fat lady and it was a difficult tap. Most spinal taps are relatively straightforward affairs (I had never not succeeded in getting the tap until last night). They are sometimes painful, but not as often as one would think with the proper amount of local anesthesia. I usually have pretty good success stabbing the old spinal column and getting that odd, crystal clear fluid to come draining out into the vials that we send off for numerous studies. (For a fun game at home, try finding your iliac crests – these are the tops of your pelvis on either side of your lower back – follow that line into the middle where your spine is. That’s about where we aim, in general, for the spinal tap.)

The ER is interesting in that I see all different types of patients with all different problems rather than simply internal medicine-only type stuff. My first patient on my first shift was a 6 year old kid who been brought to the ED by his mom after his teacher at school found the following letter at his desk: (Using “Kevin” as the boy’s name (that’s made up to protect patient confidentiality, of course), the letter read “Kevin is stupid, Kevin is a dork…Kevin should kill himself with a knife or gun…”) The whole thing was incredibly cryptic. Half the words were misspelled (i.e “stoopid”), and some of the “b’s” and “d’s” were flipped around – the whole letter looked like a movie prop. Anyway, I’m certainly no child psychologist, and didn’t really know what to do about it, so the ER staff docs and I called in the psychiatrists and an appointment was made for the following morning.

It was odd, though, as the kid himself seemed the most normal little 6-year-old kid you could think of. He was playing with his toys. I asked him who his favorite super-heroes were and he said “Dragon-ball Z and then the Hulk”. (Not to worry, I quickly corrected him…). The whole thing was surreal. In all honesty, it was probably nothing (the boy’s mother said he hated disappointing his teacher, and she had corrected his “handwriting” earlier in the day), but with society today and all, the kid ends up in the emergency room at a hospital. Let the social commentary begin…

So I’m headed back to the ER tonight and then I’m back on day shifts starting Saturday. That will certainly wreak havoc with the old body clock. For now, I just woke up, had some “breakfast”, and am off for the weekly hoops game, which will be weird as a “morning” event.

This weekend, on Sunday, is our “Department of Internal Medicine Residents’ Retreat” up at Crystal Mountain. More on that debacle as is arrives. Right now I gotta move, STAT!