Long Day, But It’s Okay

Here’s a true story from my yesterday, as in, New Year’s Eve 2019:

I had wrapped up my clinic and was looking forward to maybe leaving the office earlier than usual. Most of our docs have been away for the holidays, and I’ve been one of a pretty small skeleton crew covering everything. While I don’t mind– I mean, I’ll be taking a vacation at some point and needing coverage, too– I’m just tired. It’s been a lot of heavy OPP. That means Other People’s Patients, of course, and by heavy, I mean complex management of some really sick OPPs. It’s brain-taxing, heart-aching work sometimes. And yesterday, I had thought that maybe I would catch a break and be able to do something pure fun, like take my daughter to the nail salon before we had to be places.

So with that attitudinal backdrop, things happened to keep me in the hospital way later than I’d planned. But, in the end, it was all okay.

So what happened?

I got a page from the emergency room. My patient was there, definitely sick, maybe too sick to go home, and without a clear diagnosis, but insisting on going home anyways. (I can’t share any clinical specifics, for medicolegal reasons.) The phone conversation between me and the poor resident was brief but several things were clear: The ER was absolutely overrun with all kinds of illness and trauma; They were making an effort to figure out my patient; But they were leaning towards admitting her because they had no bandwidth.

I’ve worked in these settings, I know the deal, but I also know my patient. I heaved a big sigh, grabbed my white coat and stethoscope, and made my way down to the 24-hour human experience party that is our emergency room. Which was exactly as you would expect it to be on New Year’s Eve, except it was still only like 3 p.m. There was a traffic jam in the ambulance bay area. There were already rows of revelers sprawled on stretchers in the hallways. Concerned friends and family were camped out in every nook and corner, disheveled and resigned, some with open takeout containers. A couple of security officers muscled past me, rushing to a situation in the psych unit. I almost got run over by an enthusiastic gurney driver. I witnessed two surgical teams with procedure kits in hand politely yet firmly discussing who would get the only available room. Loads of drama.

I found my patient and her family, and to make a long story short, also found a live interpreter so I could get a good history, looked at all the labs and imaging et cetera, paged a specialist who not only called back but also discussed the case with me in detail and formulated a likely diagnosis and appropriate treatment, then I went back to the room with the interpreter and the resident, and explained everything to everyone, including a safe discharge plan. The resident was thrilled, literally typing up the discharge orders on her wheelie laptop as I spoke. The patient and family were thrilled, they got to escape before it got really crazy down there. Even the interpreter was oddly jazzed about it all.

Even though all of this took a lot of time and was a little annoying, and I didn’t get to leave early and do fun stuff with my kid, it’s still easy to frame the whole experience positively. It is pretty cool to be able to solve people’s problems sometimes. It’s wonderful to care for patients I’ve known for over a decade now. It’s awesome to work with specialists who are smart and helpful and unafraid to opine on the record. And, it’s even invigorating to work in the ER once in awhile.

Overall, a long day, but it’s okay.