I was working a 6 p.m. to 2 a.m. locums shift a few months ago and was preparing to leave. There were about 15 patients in rooms and 15 waiting to come back. I asked the lone night physician: "Hey, do you want me to stay a while?" Her answer, defeated, was this: "No, don’t worry. It’s always like this." I packed my bag and headed to the hotel, still feeling guilty ...

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These days, I work most of my shifts about 45 minutes from my "house on the hill." At one of those jobs, the day shift starts at 6:30 a.m. Which means I’m rising from my bed at 4:30 a.m. in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world. I lay out my clothes ...

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Ah, EMTALA! The revered Emergency Medical Treatment and Active Labor Act! It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training.  "And then the bad doctor sent the poor lady to another hospital because she couldn’t pay!  And the King came and crucified him for doing it!"  The end. EMTALA, for the uninitiated, is ...

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Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them.  Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are ...

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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 ...

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Many young physicians in training have asked me, quietly or by e-mail, "Is it possible to be a Christian and practice emergency medicine?"  I think that they ask a good question, and likely for good reasons. In their rotations, they have witnessed, first hand, life in the ER.  They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors ...

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I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following:  "Follow up with your primary care doctor."  Or, if they didn’t have one, "Follow up in one week with a primary care doctor."  I laughed to myself.  Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we ...

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I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9 mm, in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC. As uncomfortable as the whole experience was (and it wasn’t my ...

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My most important patient requires my constant diligence. For this reason, I am seldom far away from him. Only a few minutes inattention and there will be problems. I cannot forget my patient; I am trained to attend to him constantly. I am a professional, and my patient is, ultimately, my customer and the customer’s service is paramount, I am told. I am reminded by policies and procedures as well, ...

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I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs. I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in ...

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