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.