Most days at work are great. Some days at work can be long, frustrating, and make you feel like you were shit on by a herd of African elephants that had just eaten Indian food. When those days come around, all you need is a single breath of fresh air to make it through the day. That, or one sassy black woman wearing a turtleneck. 

One sunny day in July, a patient came in to the Emergency Department after a motor vehicle collision, and had some neck pain. Me, being the the incredibly astute physician that I am, decided that some imaging was in order, and sent the patient for x-rays of her cervical spine. While checking for the three views of her cervical spine a few minutes later... I notice something odd. There are only two. ONLY TWO. WTF, x-ray dudes. So I call  over to xray: 

Dr. Z: Art, what's with Ms. Turtleneck only having two views of her c-spine? What happened to the odontoid view
Art: She wouldn't do it, buddy. She refused. Just got all upset and said it wasn't gonna happen. 

*cue Law & Order music*

Dr. Z: Hi Ms. Turtleneck. I've taken a look at your x-rays, and for the most part they look good. I only have two of the three views that I need, though, so I can't say that everything is ok with 100% certainty. Why wouldn't you do the third view? 
Ms. Turtleneck: Baby, listen here. You cute and all, and I like you. I don't know where you from, but in my neighborhood, when a strange man asks you to close your eyes and open your mouth, he best have bought me dinner first or I ain't opening shit.

Game, set, match, sassy black woman in a turtleneck.  




Emergency departments come in many different shapes and sizes. Small, large, quiet, busy, country, urban, blah blah blah. Some departments operate on a one big room type of strategy, where all patients are placed into the same unit, regardless of complaint. Emergency departments can also be broken up into different areas to better streamline patient care, such as directing patients with minor ailments to a fast track department, moderate complaints to an urgent care unit, and the sickest to the main department ("the Main"). 

I work in the latter. Sometimes its great, such as when you're working a fast track day after a few days in the Main - you know that although you will see many more patients, the acuity will be low, nobody will die, and the worst part of your day will be saying "no" to the guy that comes in telling you that he lost his Percocet and he only had his 90 pill prescription filled yesterday.  Another nice aspect of having the department split up into different units is that we have a large number of attending physicians that are on, at any given time. Two people will man the main, and there will be one doctor in urgent and one in the fast track unit. Four doctors - and we can all help each other out if the need arises. 

Or so I thought.  

The other day, I had a little emergency of my own. I came into the Main for a morning shift. After seeing a few patients, and drinking a couple of coffees, I had... well, I had to leave the department for a few minutes. If I was Al Bundy, I would have folded up a newspaper under my arm and announced to the room that I'd be gone for awhile.  

Anyway, I'm about a minute into my leisurely escapade, when an announcement blares over the PA system:

"We need a doctor in room 8. Can we please get a doctor in room 8!"

Knowing that my partner was also working in the department, another physician was in urgent care, and a third was in fast track, I thought that one of them would get to the room first. That annoucement is never made unless a doctor isn't immediately available. Nonetheless, I began the process of getting out of the bathroom - just in case. It was a good thing that I did, because the next thing that I heard was.

"Doctor in room 8, stat!"  


It took me all of twenty seconds to wash my hands, and dry them on my scrubs as I trotted to the department. Sure enough, I was the first doctor in the room. A young man had been brought in by paramedics as an overdose, and the nurses had already had him lined and were hooking him up to the monitor. This was the report:

"Yeah, we got a call from somebody that said that this guy was on the ground and wasn't responding. Nobody was there when we got there, so we had to kick the door in. He was surrounded by liquor bottles but we didn't find any drug paraphernalia. We gave him some naloxone and he woke up a little, but that's all we got."

Okie dokie. I start calling out orders while I examine the patient... he's drowsy and confused but attempting to follow commands. The nurses have more naloxone at the bedside, so he is given a small dose and doesn't improve at all. He's denying any drug use, and appears very uncomfortable and quite diaphoretic. When the blood pressure cuff read 230/120 mmHg, I know that this man may be a little sicker than just a simple overdose. He is rushed to CT, where he is unfortunately found to have a brain bleed. He begins decompensating, requires intubation, multiple infusions, neurosurgery consultation, and a trip to the Intensive Care Unit. 

I get back to my seat, feeling down for his family, and feeling as though I've lost my opportunity for a bowel movement. That puppy isn't coming back until I start to drive home and I'm stuck in traffic. I can picture myself now, sweating while I pull into the driveway and running into my home, ignoring the dog and making a beeline to the bathroom.  Great. 

The other doctor that I am working with is sitting at his computer, beside mine, charting on his own patients. After a minute, he looks over at me and we have this brief conversation: 

Other doctor (OD): What happened in 8?
Dr. Z: Oh. Young alcoholic came in obtunded, ended up having a brain bleed. Pretty shitty. 
OD: Yeah, that sucks. I'm really sorry that I wasn't able to get into the room before you, but I was in the middle of an LP
Dr. Z: Oh, no worries. I was in the middle of a BM. Yours was probably more important. But less satisfying. 

We laughed, and then we realized we still had more than 8 hours to go in our shift, and the laughter died. Like I do, inside, every day. 




Cardiac arrest. Sepsis. Intracranial hemorrhage. Flash pulmonary edema. Gunshot wounds. Open fractures. Violent psychiatric patients. Women. The emergency department is a high action, high octane place, with life changing decisions made on a minute-by-minute basis. That's why today's story hits so hard. 

I took care of a woman in her 50s today who came in with a complaint that rocked the very foundations that this profession was built on - knee pain. She described to me a bilateral knee pain that had been plaguing her for well over 6 months, but TODAY - today was the day that she made the difficult decision to come into the ER and annoy the shit out of me with her complaint.  

Dr. Z: Why don't you tell me what brings you in to the hospital today?
Annoying Woman (AW): My knees. Doctor, DOCTOR. My knees be hurting all the time. Why? Why are they always hurting? For months and months they always hurt. I keep calling my doctor all the time, and he sent me to a specialist but I never went. Today when I called him he said, "Go to the ER." 

Oh hey. Hey you. Primary care doctors. Go punch yourselves in the face, a lot. Like, more than 14 times. I know its the weekend, and its 6 am, and you're really tired of answering calls from the crazy woman with chronic issues... but STOP SENDING EVERYBODY THAT ANNOYS YOU TO THE ER. You know what you should do? Stop giving out your cell phone numbers. I know you want to be the trustworthy doctor that can text with your patients, but stop. Just stop. Would you give a hooker your bank card? You would? Nevermind. 

I saw the patient, spent some time with her explaining what her issues were and why she would need follow up with an orthopedist, treated her with pain medication, and had her smiling as she left the emergency department.

About a half hour after the patient was discharged and left the hospital, our secretary received a phone call... from the bus driver that had picked up my patient. Yelling into the phone, the bus driver told the secretary that the lady in question still had knee pain, and should have been admitted to the hospital overnight. He was now going to take a picture of the patient, with his cell phone, so that she could sue me and use it in court. 

This interests me for a few reasons. Firstly, what the hell kind of picture was he going to take? Was it just a picture of the lady writhing around in agony on the floor of the bus? Was she standing next to the seat at the front reserved for the disabled, pointing at it and looking sad? Would the picture be Instagrammed so as to highlight the pain in her knees, while blurring out the rest of her features? Would he be artsy, and focus in on a solitary tear that is slowly rolling down her left cheek? Would it be a Vine of the lady trying to get on the bus, unable to climb the bus steps, and subsequently being rescued by the bus driver as he carries her to her seat? Or would it be a photograph of the prescription that I gave her that wasn't Percocet?  In hindsight, I should have given the bus driver my cell phone number so that he could text me the picture that he took, and relieve me of the hours that I would spend laying awake at night wondering these things.  

In the end, I learned two things:  

1. I hate people. More and more every day. 
2. Bus drivers are the worst. Except for the one bus driver that absolutely destroyed that one ratchet chick with an uppercut...  MORTAALLL KOMMBBAAAATTT!





Finishing work at odd hours allows me to enjoy experiences that I would have otherwise missed out on - please see below. 

A nice young couple watches my dog (AKA the love of my life) sometimes, usually when I'm working an overnight shift in the emergency department. The other night, they were kind enough to allow me to pick him up at 430am, on my way home from work. Why was that amazing? Because instead of going home and struggling to stay awake watching Sham-Wow infomercials until I could go back and pick him up at 7am, I was able to grab that warm little monster and head straight to bed.  

The following day, I sent them each a text to thank them for the good deed that they had done for me.
She responded with, "No need to thank me. Because he wasn't in bed with us, I got to cuddle Jeff* before work!"
He replied, "Please feel free to pick him up early ANY TIME on those overnight shifts."


So, yes, he definitely got it in. I take full credit. 

 *names changed to protect the sexually sated



I came home the other night and told my SO about my day, which included a brown recluse spider that was running loose throughout the emergency department, as well as an examination of an odd rash on an elderly man's scrotum. This, I discovered, my wife found hilarious.

As she lay on the sofa, cackling with her head thrown back, she was barely able to get the words out:

"Babe... your job is so bad... oh my God... please... don't ever let me complain about my job... oh man... a gross hairy spider and an old guy's balls... hahahaha... oh, what did you do today? Oh I just looked at a guy's balls and ran away from a spider... hahaha..."

I thought it was a fun day. Different strokes, for different folks.