Being an ER doctor isn't all fun and games. Well, it's usually fun, and mostly games, but really we're at the mercy of the city and its drunk and dying denizens. When two trauma 1's roll through the door at the same time, a scattering of chest pains and GI bleeders are still waiting to be seen in the back rooms, and the hallways are filled to the brim with gurneys... well, my heart rate starts to rise.
I enter autopilot, and start doing what I loathe the most - overtesting. It's what emergency physicians refer to as "moving the meat." It's a term I hate, but when there are multiple patients needing to be seen - any of whom could be dying - and the department is bedlam, it starts to make sense.
Chest pain? Check. How long? Describe it for me. Risk factors for cardiac disease. Labs, chest x-ray, pain control, next room. In and out the door in a couple minutes. Scribble on the chart, "typical chest pain story, patient appears well and in no acute distress, check labs. EKG nondiagnostic, will evaluate xray for pathology and admit for observation."
It becomes formulaic at this point. Patients with abdominal pain get "belly labs" and a CT. Headaches get compazine/benadryl/decadron and probably a CT & spinal tap. Traumas get "trauma labs" and a $15,000 full body CT scan to search for any hint of bleeding - it exposes them to approximately half the radiation experienced by survivors of Hiroshima.
My normally friendly bedside manner goes out the window. I'll usually introduce myself, "Hi, I'm Doctor Zac and I apologize for being brief. Unfortunately an SUV just overturned on the highway and they'll be arriving in 5 minutes, so I just wanted to pop in and see how you were doing."
I never yell, but I can be brusque. Before residency, I would have never imagined myself to be the type to say "I'm sorry, I don't have time for you right now," but it happens. At least I always say "I'm sorry" first.
I suppose it's part of being a feast-or-famine specialty. We don't have the luxury of scheduling our patients. It still leaves an unpleasant taste in my mouth when I don't feel like I can care for people the way they need to be cared for. Especially when it means spending thousands of dollars of their money that I know they don't have, and delivering enough radiation to possibly cause cancer down the road.