A 6-year-old boy with abnormal pupils and gasping for breath. A 26-year-old pregnant woman with a gunshot wound to her abdomen. A 54-year-old male with blood pouring from a wound in his thigh. Now add 43 more patients. Imagine you are the paramedic at this scene.  Who do you take to the hospital first?  Who do you have to choose to walk past and leave at the scene while you take your patient to ...

Read more...

Mrs. Liu, who was only 58 years old, had metastatic ovarian cancer. Despite radical surgery and chemotherapy, her disease persisted. Worse yet, her PET scan from a few months ago revealed that she had carcinomatosis -- numerous deposits of cancer showered throughout her abdomen. This particular night, she starting having more nausea and couldn’t eat or drink anything without vomiting. So, she came to the ED. I was called into ...

Read more...

Those of us who work in emergency medicine have all had these patients. They present with a complaint that started two years ago and for whatever reason now deem it an issue that needs immediate attention in the ER. I had a patient like this recently who not only had the issue for two years, but also had a primary care provider. Not only did the patient have a PCP, ...

Read more...

A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, "the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any ...

Read more...

To her it was like any other day. She had dropped him off, as was their usual routine, and gone into the city to see a friend. He was an experienced member of the ski team. Practice was familiar. Take the lift up, ski down. Take the life up, slalom down. Take the life up … It all happened quickly. He slipped through rail of the lift. The impact on the cold, ...

Read more...

Recently, a patient of mine died of cancer, whom I loved very much.  She had a special way of enjoying life; a half, wise smile that after our many years together did not take me too seriously and reflected her deep inner strength.  She taught me about joy; I will miss her always.  Her husband, understanding my loss, said that it was alright, that I had done my best, that he ...

Read more...

I’m pulling on my last elbow’s displaced wrist when a nurse pops in, and tells us a critical patient is two minutes away. “Mind staying?” my colleague asks. “Sure.” Paramedics are hunched over the patient as she is wheeled quickly into the resuscitation bay. At the top of the bed, a mask is secured over her mouth and oxygen is pumped with loosely gloved hands. It isn't helping -- her skin is grey -- like ...

Read more...

Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER. You may get lucky, and find yourself ...

Read more...

I’ve never been the doctor who yells.  However, if you work in medicine, you’ve met him or her.  I’ll call this physician "Dr. Barkus Yellby."  Dr. Yellby is angry.  A lot.  In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted.  Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated ...

Read more...

I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed ...

Read more...

139 Pages