Another busy shift in the ER brings another series of surprises.
Such is emergency medicine, filled with the unexpected…
This man i saw yesterday with abdominal pain, he feels much better this morning but i must tell him that his pain, it’s not his gallbladder stones, it’s cancer, terminal metastatic, inoperable cancer. He is in shock, i have seen this look of surprise countless times before and i must accept it… He must deal with the fact that this is most likely the last year of his life. I welcome his pain as i welcome the tears in the eyes of his spouse. In the flow of emergency medicine, we learn to deal with these emotions. I let them touch me, they help me do my work. Some people, we can’t save but that does not mean what we can’t help them live better, for the time they have left.
We are all born dying, what really matters is how we spend the time we are given…
Keep going, one more patient, a demented elderly woman accompanied by her son. She seems more confused than usual and won’t walk or eat. She is dehydrated. Her vitals signs show no fever. But on exam, she is definitely warm to touch. Check her rectal temperature. As suspected, she is febrile. Turns out it’s another case of urosepsis or urinary tract infection. We see this every day. A little bolus, a few doses of antibiotics and tomorrow, she will be up again, walking, smiling, eating and heading back to her home.
Even in a job filled with the unexpected, there is a certain routine, repeated steps, like a dance. Assess, investigate, treat, discharge, repeat. Assess, investigate, treat, admit, repeat. I often become self-absorbed by the rythm of my work and forget everything. This is called flow.
“Mihaly Csíkszentmihályi outlines his theory that people are happiest when they are in this state — a state of concentration or complete absorption with the activity at hand and the situation. It is a state in which people are so involved in an activity that nothing else seems to matter. The idea of flow is identical to the feeling of being in the zone or in the groove.The flow state is an optimal state of intrinsic motivation, where the person is fully immersed in what he is doing. This is a feeling everyone has at times, characterized by a feeling of great absorption, engagement, fulfillment, and skill—and during which temporal concerns (time, food, ego-self, etc.) are typically ignored.” — Wikipedia
I agree with this 100%. I am happy when i’m in flow, when i do my work.
Suddenly, the rythm breaks. My phone rings.
– Doctor, you are needed STAT in the resuscitation room.
As i walk to the resuscitation area, i prepare myself for whatever awaits… i find my calmness inside, it is where my expertise lies. Stay cool, think fast, be systematic, this is how we do our best work in the emergency room.
Two year old girl, brought in acute respiratory distress. Holy shit, oxygen saturation is 77%. This is an ominous sign that we rarely see, we are dancing with death now. One misstep and she could die. Hell, she could die even if we do everything right.
Stay calm, breathe, GO! Listen to her lungs: no air entry, expiration is prolonged, respiratory rate is in the 70’s. Quick story: looks like a respiratory infection. It goes like this: Nasal succion, optiflow, get iv access, give a bolus, large spectrum antibiotics, multiple courses of nebulized adrenaline, multiple courses of ventolin-atrovent, reassess every few minutes. Stop and think. Am i missing anything? Is this influenza? Will she benefit antivirals? Don’t think too much, shoot and ask questions later. Better safe than sorry. Order the antivirals. Is this asthma? She seems to respond to ventolin. Does she need solumedrol? Just shoot. Go.
One hour later, there is some improvement but she is too sick to stay here so i transfer her to CHEEO. We are waiting for the ambulance. My colleague and friend, the pediatrician is here, she’ll accompany this child so i can keep working in the ER. There is still over 12h of waiting time to see me. We did good work but my day does not stop now. I must go and see more patients.
Before i leave, i see the mother. She is visibly anxious. I walk to her. I talk to her. I answer her questions. There are tears in her eyes. It’s her baby and she is very sick. I give her a big hug. I tell her that i treated her girl like it was mine, i gave her everything i got. She says thanks and i leave to continue my work and find flow again.
At the end of this day, i will have seen only 15 patients. This is far from the 20-25 i could see if all my patients where walking, talking and good looking. Some people take more time, especially the sick ones. At the end of this day, i will have had the privilege to touch the lives of 15 people, maybe save one or two.
I’ll finish this post with the same comment as yesterday because i don’t say it enough. I am part of a team.
The nurses, the inhalotherapist, the doctors, the clerks, everyone working in the emergency room, they are like me, fueled by the desire to help people. When we are a team and when we work as a team, great things happen: we save not lives, we save people.
Thank you.
Original post Facebook, March 2016
Martin Pham Dinh 