Exceeding the stool limit in the emergency department

Not long ago our emergency department got a call from the health department informing us that we had exceeded our stool limit. Not quite sure how this was measured, who sets the limits, or even why such a call would be necessary, but I do know that once again we have seen a lot of stomach flu running around. Unfortunately, we can’t just tell patients to stop pooping, so I’m sure we will be heading into stool excess again.

Other things besides illness seem to similarly come in waves that force us to exceed what we think should be our limit. We have had to give dismal reports to an excessive number of patients. A member of our ED family had her 8-year dormant breast cancer come roaring back. She would fight but lose the battle this second time. Another older patient was coughing up blood from a tumor that had eroded into a lung vein. He would die soon if the vein wasn’t sealed off. He looked at his family and our staff in the eyes and said that he was ready to die and was going home. He did both.

We’ve also had to tell the families of far too many “young” patients that their relative had died. One was hit by a car while helping another person that had been struck and injured. Another reportedly was exceeding the speed and legal alcohol limits when hitting some curves. Yet another was found with their phone in the middle of a text. Others had completed suicides or had non-resuscitable overdoses. This nasty part of our job never gets any easier.

One shaken baby is more than our limit. A recent surge of shaken babies, beaten kids, babies being born an addict, and children neglected because of substance abusing parents has our ED staff feeling like we have been beaten up as well.

Breaking records for the number of overdoses in an hour or for the total milligrams of Narcan administered to one patient or administered during a shift is something we note with our heads held low to the ground. A long time ago we all reached what we thought was our limit of obnoxious drunks, homicides, new mind-altering substances, suicides, cystic fibrosis, ALS, massive strokes, domestic violence, and being aimed at with bodily fluids, expletives, and even fists, feet and weapons.

The river of feces will never completely stop, but we’ll keep trudging through the nasty stinky stuff together — even when we are over the limit — or feel like we are in over our heads. A tip of my sweaty well used hat to all my fellow ED team members (and our families as they help also) – and especially those that have slogged alongside me over the years. We’ll plod through this.

Joe Bocka is an emergency physician.

Image credit: Shutterstock.com 

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