Talk about ED overcrowding! Today was crazy, busier than I’ve ever experienced it, and the pace was faster than non-stop. To start the day, the hospital was “full” which means that they are out of nursing staff…the beds are physically there, but without nurses to take care of patients. So the ED was full of inpatients, patients that have already been admitted but are stuck in the ED. As a result, we can’t see as many new patients, but the number of patients comign to the ED to be seen doesn’t change…soooo…patients sit in the waiting room waiting for an ED room to open up that’s not opening up because the inpatients are just sitting, waiting. Being a Saturday, the services are short staffed, and rounds start later, so the inpatients don’t get seen for several hours. Family physicians fielding calls over the weekend are referring patients to the ED, several traumas arrive at once, fortunately mine was not unstable because the trauma team was next door busy with another patient.

So I end up sitting around, waiting for new patients to show up, not realizing that they are all piling up in the waiting room. Our residents get called in early to help us see patients. Finally, the crunch happens…after a few phone calls to “the administration”…inpatients leave, rooms open up, and our backlog of patients comes flooding into the department like the Hoover Dam has just broken loose. This is not the first time this has happened. Inappropriate referrals and unrealstic expectations result in needless visits, yet each consumes precious time while sick patients are filling up gurneys in the hallways and even in the new construction areas not intended for patient care. Madness.

And of course, a decent day of medicine and trauma gets ruined by two painful “psych evals”. Ugh. Another “make my [insert relation here] behave” visit. Sorry…that’s not my job, I can’t help you, sign here please. Ma’am, it’s just a discharge form, it says you are leaving the department, please sign it. No I can’t make a copy for you before you leave, you get one copy, do whatever you want with it. My pearl of wisdom to take home: Screwed up parents raise screwed up kids.

And my last patient was seen in the parking lot. Actually, seen leaving the parking lot. His family had convinced him to come to the ED for a “medical checkup”, when his real problem was for psychiatric illness, most likely the manic phase of a bipolar illness. He bolted out of the car and left hospital grounds when he found out from a family friend that we would “do blood tests”. I went out to the parking to speak to the family and make sure that he was not about to hurt (that is, KILL) himself or anyone else. My best impression was that he was simply manic. Euphoric mood, delusions of grandeur, vanishing to distant locations. So I told him I can’t force him to come in. Dad was upset that he was inconvenienced by these “rules of society”. Umm….what rules? Does he want me to arrest everyone who acts a little odd and bring them in for a drug test? Sorry…can’t do that.

Remember that pearl from before about screwed up parents? Anyway…