The Zen of Medicine

“Hey, Shazam, when are you supposed to get out of here?”

“Two hours ago.”

“What are you still doing here?”

“I have five patients I can’t get rid of.”

“That’s what you call a rock collection.”

“Yeah, I’m starting a rock garden, but I’m not feeling very Zen-like.”

So went my entire day, from patient number one, an inappropriate referral from a hospital 2 hours away, to the final patient who was bounced back and forth between medicine and cardiology before I finally was able to get the fellow to come down and say hello to her. Two patients I waited for radiology to call me back, “Mr. So and so has some air in his spinal canal, I’ll call you back in 15 minutes and let you know if there’s a fracture.” Wait, wait, wait, two hours later and radiology still isn’t returning my pages. I finally ask him when I physically track him down, “what about that air in the spinal canal?” “Oh, forget about that.” Let me give you tip, dear reader, if you are a radiologist, and you tell someone that their patient has air in their spinal canal, you’d better return the call about the fracture within 15 minutes, rather than waiting 2 hours and saying, “Nevermind.”

One patient told the triage nurse that he was going to go home and “blow his head off” if he didn’t get some relief from his back pain. Now we’re obligated to do a psych eval on him as well, even if he was just being dramatic. He had seen a pain specialist a few months ago who was able to provide some relief with an epidural injection, and asked me why I couldn’t give it to him tonight. I felt like punching him when he asked…that’s what you have a primary care physician for, to help you get to the right place (an anesthesiologist specializing in pain medicine) If you’d follow her advice and call her when you’re having pain, you wouldn’t have needless visits to the ED.

Another patient was having incontinance and difficulty walking. The urine would be the pivital point in my evaluation of his symptoms, I was sure he’d have an infection. So I order some tests, only to find out two hours later when I was ready to send him home that his urine hadn’t even been obtained yet. (It was busy, and my order had been misunderstood). When the nurse tried, she discovered that she was unable to pass the foley past his prostate. Now an entire new set of problem solving skills is needed. Ugh. He’d already been here for 4 hours.

One patient was a bounceback from this morning. I tried paging medicine no less than three times in an hour to admit her with no response. I called the operator who told me “we can’t overhead page unless it’s an emergency.” Without thinking, I responded, “Well, we are the emergency department.” The operator required us to call her a second time before she finally paged him overhead. When he called, the first thing I asked was,

“is your pager working?”

“Yes, it working [sic]”

“Well we paged you three or four times in the past hour.”

“I don’t know [sic]”

“We have two patients down here for you.”

“Two?”

“Well, if you’d called back an hour ago, we’d only have one for you now.”

“I was up on floor with patient. [sic]”

Ironically, the two (or was it three?) suicide attempts I admitted were the quickest of my admissions. Even then, it took me an hour to get ahold of a psychiatrist to accept the first patient. I hate days like this. No matter what I did, I felt like I couldn’t get anywhere with any of my patients. How do you deal with delays like this in private practice? How do you develop Zen when you’re growing a rock garden in your ED? For you non-ED physicians, please excuse my jaded interpretation of the days events.

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