Wednesday, May 2, 2007

I Love New Docs, Part 2

It's a normal night in the ER. Not much going on, but a lot of patients. When there's nothing but clinic stuff in the waiting room, we try to keep two beds open; one cardiac/trauma bed for any real EMS patients, and then the Code room. Sore throats and earaches have been known to circulate through the Code room because you can park them in a chair in the hall if a Code comes in. Any other beds are pretty much doing the revolving door- "Here's your Lortab and your work note, follow up with your family doctor (who you should have gone to in the first place) in 2-3 days."

EMS calls in with a Chest Pain x 30 minutes. They report initial pain as 2/10, no other symptoms but a little nausea. Nitro made it 0/10, vitals are totally dead normal. But she's a 55 year old female, so we're waiting with the whole 9 yards just in case. (That and the fact that none of the 25 people currently in the ER even really need to be here...)

So they get there with Nice Church Lady Martha, and surprise, surprise; 12-lead shows gnarly ST elevation. Kinda like CharityDoc's only not quite that cool. One of our Super Nurses had this patient, and she had everything out and ready to go before we realized that our doc on that night was a TNKase virgin. He was a bit reluctant, (I think the speech about possible adverse reactions scared him more than the patient) and understandably so, because TNKase is a pretty serious thing to give. Anyway, they got through it, gave it, and she was doing as well as could be expected, waiting for transfer to the Big Heart Hospital in the Big City down the road.

At the same time, EMS calls in with another Chest Pain, only this one is ETOH positive, combative as hell, and apparently on something besides Jack Daniels. They are inclined to think that she's a legit Chest Pain, though, because she's got a second degree heart block and her BP sucks. So she gets the Code Room. (Which incidentally is right across the curtain from the first MI.)

Well, when she gets hooked to the 12-lead, she doesn't have a second degree block. Nope, she's sinus. With gnarly ST elevation. Swear to God, they were twin EKG's. Meanwhile, Trailer Trash Suzie is screaming for pain medicine, won't answer any questions, is denying drinking, drug use, medical history, etc, and her daughter is standing there yelling at the nurse because we're "being mean" to her mom.

New Doc hasn't recovered from the first TNKase 20 minutes ago. Super Nurse is pretty much on her own in with Nice Church Lady, dealing with the reperfusion bradycardia and increasing pain all by herself, because we're all in the Code room dealing with crazy drunk MI. It sounds (and smells) like the cheap seats at a NASCAR race, only I can't tell what the high pitched whine is, because there aren't any cars in the Code room. And then we all realize; it is the sound of a New Doc growing his testicles.

"Enough!" he shouts. (And he's a big guy, so it was an impressive, 'shut the hell up now' type of shout). He looks at the daughter and says, "We're not being mean to your mom, we're trying to save her life. So either help or get out." And then he looks at no longer screaming Trailer Trash Suzie (I'm telling you, it was an impressive shout) and says, very distinctly, " If you don't start helping us out here, and stop lying to us, you are going to LEAVE HERE IN A BOX! Now tell me what drugs you've been doing."

Trailer Trash Suzie became a tad more helpful, Trailer Trash Daughter picked up the slack, TNKase was given, both patients were transferred to the Big Heart Hospital, and it was a happy ending all the way around. Suzie and her daughter came in about 2 weeks later trying to get the names of the paramedics that brought her in, because they were "mean to her". We didn't help her out.

And New Doc has a pair of shiny new testicles. I've seen him use them several times without any hesitation. I think they might be stainless steel. Which is good, because he'll need them around here.


Anonymous said...

shiny new doc is obviously not ABEM board certified and not residency trained in Emergency Medicine. If he is that easily flustered, he obviously has not pounded the floor of the ED long enough. Either that, or he came from a very weak program.

ERnursey said...

Maybe he is still in residency somewhere, at my teaching hospital they moonlight in outlying hospitals while still in residency. A scary practice, the most inexperience doctors go to the places where the least amount of resources are available.

Anonymous said...

Fly by the seats of your pants is the best and most dangerous ways to learn.

MonkeyGirl said...

Anonymous #1- Don't talk shit about my Docs. That's my job. We're a little hospital in a little town and he's a brand new doc. He's only about 12, for crying out loud. What, you came out of Med School with a set of brass balls and the knowledge of a crusty old guy to back it up? Congratulations. He's just a normal person, like the rest of it. He does a damn good job with such limited resources. I'd prefer a doc who hesitates for a minute to think things through in some cases. It's not like he had to call his mommy and ask permission, or anything. Everybody gets their experience somewhere. Glad yours came prepackaged. The rest of us pick it up as we go.

Just A Midwife said...

Ohmygods, MonkeyGirl, 3 dogs just came running to see what I yelped with laughter about!! At least now I'll be able to recognize the sound if my (not new) doc ever suddenly grows a spine.

Full-On-Forward said...


Hi. Trying to post but I screwed up and don't even know my password. Hell I don't deserve to be posted then. But it sounds like your new Doc will do just fine- He grew Cojones on a very fast learning curve!

We all lnow the Nurses run the ED anyway- sounds like you have a great crew! LMAO in SC!


Anonymous said...

Hear, hear Monkey girl! Keep up the great posts. Anonymous #1: What! you think that only ABEM certified, residency trained ER docs can do good work in the ER or have appropriately sized testicles? I bet that most of the better ER docs in Monkey girl's setting (small community hospital ERs) aren't ABEM certified or did ER residencies. Don't go trashing docs who do good work whom you know nothing about.
Definitely blogrolling you, monkey!

Anonymous said...

I am a nurse in a teaching hospital. One of my favorite aspects of my job is watching the interns confidence blossom. Great blog. Thank you.