Triage Note: Fish hook in eye. No bleeding. Tetanus up to date. It’s a sunny weekend during cottage season. A young woman is rushed into the ER as she cups both hands over her left eye. She’s in shorts, and flip-flops, and she’s hyperventilating. Her friends follow, hands similarly cupped over their mouths. I read the triage note. I’ve never seen this before. I’ve removed dozens of fish hooks -- it’s ...

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It’s 1 a.m., and I’m afraid this guy is going to die. He’s gasping for air, hunched over a table as I poke his chubby back and try to find a rib. Oxygen is flowing through nasal prongs at six liters per minute, and it’s barely making a difference as his oxygen saturation hovers around eighty-five percent (it should be in the high-nineties.) He’s sick, but what’s more worrisome is ...

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I carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.” One of them held the small urine jar up to a light and began unscrewing the lid. “Don’t!” I said. “Why not?” “It stinks. You wouldn’t believe how much it stinks. We ...

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It’s almost 7 p.m., and I’m handed the chart of a man in his sixties. “Can you see this one first,” the nurse says, “he needs an ultrasound.” I skim the triage note, which is often like reading the blurb at the back of the DVD. If it says “pain all over for eight months,” it’s not likely to be a hot new rental. Frank Martin (name changed) has been sent from a walk-in ...

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Seconds after I arrive at the ER on a Sunday afternoon, I'm called to see an elderly woman who can't breathe. She's ninety-four, and gurgling for air. On my way, I pass two middle-aged women. They are hovering outside a nearby room, trying to get my attention. One gestures like a traffic guard as she tries to wave me into the room. The other throws up her hands as I ...

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I'm seeing a fifty-something with knee pain when I feel the curtain behind me erupt open. It's Roland, my last patient, and his breath is at my neck: "Why are you being so difficult?" he says. "Why can't you just give me the prescription?" I turn, and wave my hand over Roland's head. "Call security." He's swearing again, and I can hear security's racing footsteps as a code white is called. "I have nothing more to ...

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(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.) Dr. Stephen Cluff is like Yoda. Judging by body hair, he's more like Chewbacca. But he's short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet's voice. If I'm stumped on a case, I'll ask him. If I'm pissed off about department politics, I'll call him for advice. If I want ...

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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 ...

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It's the beginning of October, it's Sunday, and it's been an uneventful shift thus far. However, in exactly seventy minutes, a patient that I've just seen -- one that I think has nothing more than an upset stomach -- will collapse and begin a fight for her life. I'm at the nursing station scribbling on a chart when a lanky man leans over me, a toddler in his arms. He's looking at the ...

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Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He's forwarded a letter of concern from a specialist from a different hospital. It's about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick ...

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