It’s hard to put into words the horror we all feel about the events in Las Vegas. So I won’t try. But what I will try to do is point out an often unspoken reality. Which is that those who work in emergency care constantly face terrible things with courage and skill and keep coming back for more. And everyone needs to remember that all those folks society counts on ...

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So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of ...

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Unless you’ve been living under a rock, you’re well aware that the United States is in the grip of a really big epidemic of opioid abuse.  The epicenter of much of this has been my beloved Appalachia.  My home-town, Huntington, WV, might as well be re-named "Oxycontin," or maybe "Heroinville."  It’s ugly. Enormous amounts of ink have been spilled on this topic, and ...

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I was recently at a meeting where some very influential physicians were discussing a question that I’ve been thinking about for a while: how do we find medical staff for rural emergency rooms and hospitals? It’s a tough question, because, increasingly, it seems that young physicians are trained to work in urban hospitals. Those are also the places these young doctors prefer to practice. Big hospitals and teaching centers in ...

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I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time.   During that time I stayed in a lot of hotels.  But, occasionally, I had more unique accomodations.  Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal.  I actually like sleeping in airports occasionally.  When you’re stuck, you’re stuck.  Weather or ...

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I know, I know, I spend way too much time ranting about work in the emergency department. But after some recent shifts, my box of rants is full once more. And what I want to point out is the enormous struggle of the mid-sized emergency departments in America today. I know this is a problem; I work in them, and I know and talk with people who work in them. It’s ...

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After years and years of practicing emergency medicine, I’ve seen and treated thousands of children for everything from beads in the nose to leukemia, ruptured spleens to sprained ankles. A father of four myself, I take great delight in interacting with the kids that come through my workplace. I consider it a personal challenge to make them smile whenever possible and to put them at ease. I’ve learned a few things over ...

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I have never wanted to be the medical advice columnist. “Dear Dr. Leap: My feet sweat all the time. I’ve tried everything! What should I do?” Nope, I’m not your guy. Nor do I want to opine on study after study about statin drugs for cholesterol or discuss whether women should take estrogen. There are physicians who love those questions! And I think they’re fantastic. But I’m an emergency medicine ...

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“So tell me why you think you you’re having a stroke?” The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber, and when I got back to my 4-wheeler my heart was racing, and I was short of breath. My arms were tingling, and so was my face. I’m concerned it might ...

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How do you define yourself? How do you describe yourself? In the past, I have tried to avoid immediately categorizing myself by my profession. I always agreed with The Little Prince: "Grown-ups love figures … When you tell them you’ve made a new friend they never ask you any questions about essential matters. They never say to you "What does his voice sound like? What games does he love best? ...

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When I go to work, I take a lot of things with me. Everyone has their ritual, right? I take my backpack with my computer inside. I take my phone. I take charging cords, the true modern lifeline. I take lunch. I carry a pen, flashlight and pocket knife. On a more abstract level, I take the wonderful education I received as a medical student and resident, coupled with my years ...

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Sometimes medicine offers us wonderful, almost unimaginable gifts. Heart attacks that were devastating, life-altering events a few decades ago are now treated with expediency and skill that our grandparents couldn’t imagine. A couple of days pass, and the victim is home with stents in occluded arteries and directions to modify activity and diet. Pneumonia, once the "old person’s friend" (so called because it took the aged to eternity), is far less ...

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Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room: Back in the good old days, medicine was what we liked to call "fun." Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and ...

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Alfred is 95 years old, and sits quietly in his wheelchair, rocking back and forth.  His strength is gone, and his veins and tendons bulge through fair, translucent skin, stretched over muscles of long lost size and use.  His greatest foe is gravity, which holds his lithe, bird-like form in the chair enough to cause sores on his hips, but only barely.  It looks as if he might float away. He remembers little, but ...

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I remember the early trials of thrombolytics; not for stroke but for MI. During my residency, we were still comparing tPA with streptokinase. It was pretty incredible stuff. Now we’ve moved beyond that positively "medieval" method of treating heart attacks and have advanced to incredible interventions in coronary and cerebrovascular disease. Furthermore, we are able to rescue more and more people from the brink of death with advanced medications and with ...

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One of the terrible things about being a physician who has spent his adult life working in emergency rooms is that you have a certain terrible clarity about the dangers of this life. It’s why we’re forever pestering our loved ones with phone calls and texts: "Are you there yet!" Or telling the children, "Be careful! After midnight there are too many drunks on the road!" Met, of course, with ...

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It’s August. I’m looking out the windows of our log house and across the immense variety of green leaves, on oak and birch, mountain laurel and sycamore, magnolia and honeysuckle. It’s a rain forest here. Indeed, after a long dry spell, we’ve had days and days of soaking rain, with breaks in the clouds so that the sun raises steam from the earth like water coming up in the garden ...

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I’m in the midst of a run of shifts in the emergency department. I’m doing locums away from home. Last night, I left work at about 3:30 a.m. (My shift was 6 p.m. to 2 a.m.) It was busy — not "crazy busy," just "normal busy." I finished my last note, wrapped up the information about the one patient I was leaving behind with the valiant night doctor and headed ...

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Some dear friends of mine, at Busy Community Hospital, are having a momentous day.  Today is the "go-live" for their brand new, shiny EMR. For those of you outside the hallowed, creaky halls of medicine, this EMR is one of the most widely used electronic medical records systems in America.  It’s big, it’s expensive, it captures lots of data, integrates ERs, hospitals, clinics, labs and everything else.  (Probably your cat’s shot records too.) The problem ...

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I well remember being bullied on the school bus. On many cold, wet mornings (a large portion of the year in West Virginia, by the way), I found my junior-high self sitting in front of high school juniors and seniors who turned their class rings upside down, then used them to hit lesser life forms on the top of the head in a whipping motion. Turning around in pain and ...

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