The following excerpts will give you an idea of what life can be like while practicing emergency medicine in very beautiful, very coveted areas of the United States. I will not name towns or hospitals, as the situations are highly reproducible from place to place and season to season. We’ll just call it St. Resort hospital. If you doubt me, call up your friends who work in such locales, with the rich, the powerful and the well rested. Or with the sunburnt, drunk and tasteless. Vacation sites cross all demographics, but in different ways.
“Dr. Leap, I’m having chest pain. I have pretty bad heart disease, and I saw my cardiologist at the university last week. He said I probably need another stent because I’m having chest pain a lot more than normal. But my wife and I decided to drive here for the week. What should I do? My son is a heart surgeon at Mayo Clinic.” (Two hours to nearest interventional cardiologist. And of course, your son is a heart surgeon!)
“Dr. Leap, my daughter has a laceration on her face. By the way, I’m a plastic surgeon myself! (Full disclosure, I trained at Harvard and I’m faculty at Duke!) Can you tell me how you’re going to close the wound?” (Stands close by during closure, asking questions, sniffing and making subtle noises to guide technique.)
From an administrator: “Dr. Leap, Mr. Whatzit is a very, very important donor to the hospital. It’s critical that he get good care. Do you understand?” (You mean, unlike the bad care I give everyone else?)
“Dr. Leap, I live in Big City, USA. This morning, I went for a hike and now I have red bumps on my legs. I’ve been on the Internet and contacted my physician at home. He said I should be very concerned about brown recluse bites and Lyme disease, and that you should give me a prescription for doxycycline. Oh, and I’m a pharmacist.” (In the South we call them bug bites and go on about our business, remarkably free of antimicrobials. Patient unimpressed with my colloquial knowledge of unspecified bug bites.)
“Dr. Leap, I passed out! My wife and I have been married for 50 years, and we decided to come to South-Town and ride bikes to lunch. After about six miles, I felt so dizzy I just fell over! Oh, and I’m on Coumadin. And I have a defibrillator. I’m a cardiologist myself, and my electrophysiologist is at Cleveland Clinic and wants you to call.” (Heat index around 115 degrees, humidity 100 percent. What were you thinking?)
“Hey doc, I don’t know how the %#[email protected]% that happened, but I had a few &^%# beers and went out into the surf at night and stepped on that [email protected]^^ stingray. Yeah, I’m drunk. What about it!” (BP 215/110, which is also his peak and trough alcohol level. Patient hasn’t taken meds, or seen a doctor, since Reagan administration.)
“Dr. Leap, it’s the funniest thing. I mean, I’m in good shape. I row ten miles a day and run every other. But I came up here for a wedding, and I can’t breathe! I have a headache, and I’m coughing. My living? Oh, I’m a malpractice lawyer. But my sister is head of pulmonary medicine at Washington University. Can you call her? She has a few suggestions for you.” (Sea level to 10,000 feet in one day; and I’m happy to be told what to do by someone who isn’t here and thinks I’m a hick.)
“Dr. Leap, I know you say I should be admitted, and you’re right, I can barely walk with that broken ankle. But I have a camp to clean up and an Elk tag to fill. And nobody to drive me back home in my camper. So I hope you aren’t offended when I sign out and go back. Nothing personal. I’ll come back if I have to.” (This one I get. It’s an Elk tag! Who can blame him?)
“Dr. Leap, dude, I passed out on the beach, and my skin is like, on fire! You have to do something! Oh, and I left all my Oxycontin at home before we brought the RV down. Can you help me out? My doctor is on a mission trip in Asia or some ^$#^.” (Footnote: 60 percent BSA covered in sunburns, with scattered blisters. Prednisone, yes. Oxycontin? Nope. )
From a medical staff office: “Dr. Leap: here is the summer call schedule. Nobody is on call because everybody is on vacation. Good luck.” (Footnote: Technically I’m on call. For everything. At least in some locations.)
Honestly, most all vacation town folks are nice people trying to stay healthy and have fun. The same goes for physicians and administration. But poor planning, unrealistic expectation of local facilities and carelessness take their toll.
So next time you’re tempted by the scenery in that glorious add, just keep this all in mind. Remember to wear your sunscreen, acclimate gradually, and remember that 80 percent of the “manageable” annual volume will probably be compressed into the three months that constitute the lazy, hazy, crazy days of summer at St. Resort Hospital in Vacationville, USA.
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