Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, January 11, 2005

    that was one of the busiest call nights I've ever had. I was called to admit six patients before midnight. I admitted five of them, and would have admitted the sixth had I not found out, after half an hour of history-taking and examination, that he belonged to a different physician group (insurance issue; I'll spare you the details).

    Got to bed at three a.m. Paged at five-thirty for another admission. I got in at seven forty-five, after four hours' sleep. Fortunately, night shift finishes at seven a.m. so I was able to relax and not worry about yet another admission.

    While I was in the ER Saturday morning, the red phone on the wall rang. (That means unstable patient coming in by ambulance.) I saw the notes the nurse took: full arrest, intubated. Hmm. A minute or so later, in came the paramedics with the patient, one of them doing chest compressions but not with any sense of urgency. I overheard that the patient had been "found down" at a nursing home and the paramedics had been called.

    "Were they doing CPR when you got there?" asked the ER doc.

    "No," said the EMT (emergency medical technician), rather disgustedly.

    Oh well, he's had it then I thought, and went back to my admission.

    That he had, as I found out about twenty minutes later. I had forgotten all about the DOA patient as I got absorbed in my admission and treatment plan, when out of the corner of my eye I saw the ER doc talking to a woman off in a corner. A minute later the sobbing began.

    "He was fine yesterday," she managed before they walked her into the room to be with her - father? Grandfather? I wasn't sure. At that point I felt like a louse for treating his death so casually, but I was too tired to beat myself up for more than ten seconds. It's an occupational hazard, treating death like a pest or a mildly interesting event. Or, worse, an annoyance. ("This guy had to go and die and screw up my hospital rounds!")

    Please God, let me not get that anesthetized to other people's suffering.



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