I watched Barack Obama’s acceptance speech tonight, which made me think a couple of things. I should first say that I thought it was one of the most amazing speeches I’ve ever seen. I’m a staunch Obama supporter, but a few things tweak me the wrong way, being on the inside of healthcare.

Simple laceration repairs, heart attacks, food poisoning… these things make me feel happy inside. I can cure/diagnose/treat these things. These are the type of medical diseases I truly enjoy working up. Quick, easy, fixable.

However, truly “sick” people – like the woman I took care of tonight with diabetes, hypertension, COPD, neuropathy, hyperlipidemia, hypothyroid, congestive heart disease, end-stage renal disease, fibromyalgia (and more) – scare the crap out of me. She defines herself by her illnesses and the 20 medications she takes daily. I dislike caring for these patients simply because anything under the sun can and does go wrong, and the sheer quantity of healthcare dollars they vacuum up is phenomenal.

These people will never get better, return to their PCP/ER/hospital every few days, and require every laboratory, radiology, and clinical exam under the sun – every time. If my mother was one of these people I would want everything done for her, but as a healthcare worker can’t help but view her as a money sink… that could be far better spent on healthier, more acutely ill patients.

Lastly, in principle, universal health care is a fantastic thing†. In practice, 3 of my 14 patients today were very clear drug seekers, who came to Urgent Care because it was a free, easy way to get narcotics. Insurance pays for their visit, insurance pays for the prescription. People removed from responsibility abuse the system. Paying for “affordable, accessible healthcare” is one thing. Freeloading visits to the urgent care daily for 7 years like my good friend Mr. Ramirez is an entirely different story††.

†One of the huge advantages of universal healthcare is the hypothetical ability to introduce one standardized system for all hospitals. This would decrease redundancy in lab tests, CT scans, and more, allowing faster, more accurate care. In the setting of the ER, however, it would also quickly identify people who hop from ER to ER seeking narcotics.
††I kid you not. Pulling up his record on our system reveals at least one visit, daily, to the ER, for the past 7 years. Thanks, EMTALA!

Just so you all know, I seriously feel like a badass right now†. I saw twice as many patients †† tonight as the pediatrics resident who was working with me… and on top of that I stitched up all of the laceration repairs that came in.

Seriously, I love the ER. Not sure I can say it enough.

†Nothing wrong with hubris, right?
††Not that we’re keeping count, but honestly, she looked pretty frazzled as it was… I kept picking up charts just to try to take the load off of her.

My very pleasant suicidal patient the other day informed me that she would be more than happy to be admitted to the psych ward. It seems that she was a danger to herself, as she has tried to stab herself 5 times with a chef’s knife in the stomach, swallowed drano, and hung herself from a tree†. Not all at the same time, mind you, but nevertheless. Dedicated is the word that comes to mind.

I heard from a psychiatrist once that if you don’t know how crazy someone is, it’s a good idea to keep yourself between them and the door, as you don’t want to be backed into a corner by a 250 pound bodybuilder on PCP. So, I hung out near the door, squatting to make myself less threatening, and conversing in quiet tones. She was very nice to me, really.

The shit hit the fan when the nurse tried to go in and draw blood. The first indication that something was wrong was the shrill scream of “I’ll kill you, bitch, you and your whole fucking family!!!”

As she sprinted towards the door, gown flapping in the wind, the two security guards in the hall clotheslined her, and then wrestled her over to the isolation room. They finally got her in 4-point restraints, and things seemed to be going swimmingly… until she started spitting, biting, and bashing her head against the guard rail.

Luckily the quick-thinking ER doc ordered up a lovely BAH cocktail (50 parts benadryl, 1 part ativan, 5 parts haldol, and a maraschino cherry for good measure) and within minutes she was snoozing away peacefully.

I love this job :-)

†Impressive, really, because usually the whole “hanging from a tree” gig works.

And yea verily, he spoketh the fateful words:

“I start ER tomorrow.”