Yesterday was a long day for me. A long shift on an inpatient floor, during which I spent half the day cleaning up the mess the ED had dumped on me, followed by visits to my own patients in two other hospitals. I have a lot of respect for ED doctors, and I realize you are under a lot of pressure, but this is what you sent to me yesterday:
1. An 80 year old lady with chest pain and weakness and a new LBBB on EKG. She had been in the ED for about 30 hours. Her initial cardiac markers drawn when she initially showed up showed a CPK of 1200 and a negative troponin. She then proceeded to sit in the ED for another 30 hours. She got no IV fluids, no repeat EKG, and had no repeat cardiac markers sent. Then she was admitted to my non-telemetry floor.
2. A 70 year old lady who came in with decreased appetite, abdominal pain, and weakness. I give you credit for doing a rectal exam. But you didn't notice the new onset renal failure; creatinine of 6.6 (last recorded several months ago was 1.5). You didn't put in a foley. You didn't give her any IV fluids. She sat on your service for 15 hours without even getting the most basic care. You also don't seem to have noticed the enormous bruise on her back, her persistently saying "he hit me, he beat me, I don't know why," or the vesicular lesions on her vulva and the tears on her vaginal walls.
3. A 75 year old gentleman presenting with altered mental status and new onset aphasia. You did do a chest x-ray and a UA and some basic labs. But if you'd done a head CT you might have noticed the new-onset hemorrhagic stroke and you might have had more luck getting radiology and neurology to pay attention to the patient, as you are, after all, the ED.
I feel bad for the other 15 patients I was in charge of yesterday. They didn't get the care they deserved because I was busy calling radiology for stat CT's, putting in foleys and IVs because we only had 4 nurses to cover 35 patients, and drawing stat labs and bringing them myself to the laboratory because our hospital has decided to stop paying people to transport specimens.
Fortunately the day ended well. I visited a patient of mine who is hospitalized at a nearby hospital who is slowly recovering from contrast-induced renal failure, and then the highlight of the evening was visiting my African patients on the OB ward to meet their new daughter (who I unfortunately couldn't deliver as I was busy dealing with too much elsewhere).
I got home at 10:30 PM, but I know I did right by my patients yesterday (at least the ones I had time to really take care of).
