Sunday, November 18, 2007


When I first finished my residency, I thought that my training had given me all the tools that I needed to practice in my speciality, then reality set in. After residency I learned that when you are called to the ER, the first thing to do is see how the ER staff are acting. They see scary things all the time, if they are acting Freaked out, you should be. A great example of this is what happened last night. Unless they are coming by ambulance, the first person to see what is going on is the receptionist/triage person at the front desk. They are used to seeing hundreds of patients a night, so when they page you STAT before the patient is even in the ER you know it is not good. This is the dreaded SWIT PDQ call. (Something wrong in there and its happening pretty damm quick!) In this case a knife sticking out of someone's head.

Other signs that should worry you. If the ER pages you and you call back and they say "DR. So and so wants to talk to you", you know its not bad. If they say "Dr. can't talk now and needs you STAT", this is real bad. In the middle is when the Dr. is right there waiting for your call. This can be worse than bad, because not only is something bad happening but he/she aren't sure how to help it.

Above all, if the ER staff is nervous and you aren't, you are missing something important!!!!


SeaSpray said...

Hi Throckmorton-I've read all 3 of your posts and enjoyed (ya-w-w-w-n)them all. I will be back to comment(yawn)when I am more bright eyed and bushy tailed. God only knows what I might come out with (yawn)when I am this tired. My censor alarms are seriously compromised when I am (yawn)this tired and I would wake up to extreme blogger's remorse for sure.

Your posts were both interesting and entertaining. (can't stop yawning) I am so tired... I feel like Dorothy (Wizard of Oz)in the poppy fields when she couldn't stop herself from falling asleep and d-o-w-n she went. It's 9:36 p.m. and I am going to bed which highly unusual for this girl but have been burning the candle at both ends. have you ever been so tired that you could fall asleep anywhere and in any position? That's me now.Hope your not offended by my typing this (it doesn't require thinking)and I probably yawned 20 times in the time it took to post this. I'll chalk it up to being tired and this comment will probably give me blogger's remorse in the morning. Nite! :)

Now if only I could be beamed into my bed.

Throckmorton said...

I know exactly what you mean! Most of the time I get on the computer is when I just get home after being called in while on call.

SeaSpray said...
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SeaSpray said...
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SeaSpray said...

Hey Throckmorton! This was an interesting post and interesting perspective. I am so used to knowing how the ER staff reacts to or thinks of the private docs and I never considered their rxns to ER staff until reading these med blogs.

A really funny story (in my opinion) was done by White Coat Rants (an ER Doc on my blogroll) who did a post called "Chinese Pager Torture". That poor on call doc. By the end I was picturing Richard Dryfus in "What About Bob". If you haven't seen the post it is worth looking up-maybe in his August posts. Scalpel from Scalpel and Sword (another great ER blog also on my sidebar) recommended Whitecoat's post and his blog, but I digress.

It sounds like you work in a large hospital with the volume of pts you describe. We are just a little Mayberry RFD hospital by comparison although I have seen amazing things with lives being saved and Thank God they are there for this side of our county.

I never saw a knife in the head. I guarantee that would get a STAT response from me!

The stretchers rolled directly in front of my desk. I could touch the pt if I wanted too. So…CPR's in progress (patient obviously dead) you name it we saw it, although not as much drama or volume as you see in a larger facility. I had a man come in with chest pain he didn't make it to triage- sat down hard on a bench against the wall and in the next second died. Well I didn't know that - I didn't waste time on a call but bolted around the desk and hollered down the hall that a pt needed help stat. They saved his life and got him shipped down to a larger hospital. One of my most difficult memories is when a beautiful little one year old baby girl accompanied by the paramedics was wheeled in (lifeless) right in front of me with crying parents right behind them. She had drowned and they were neighbors. I didn't know them because they lived on the other end of my road. I can never drive by their house without thinking about that day. (Sorry digressing again)

This one day everything seemed to be STAT pages coming over the PA for the ER. I had just come on and the 1st shift person never told me what was going on the other side of the door. (When we were downstairs there was a sliding door between our dept and bed one in the ER which is where this critical pt was) I had to go into the ER and in unison men and women shouted "GET OUT!!!!" I had that door shut on get and heard the out through the door! And I never would have opened that door if I knew what was on the other side of the door and curtain. And I know it wasn't personal - they were in the heat of the moment. More STATS called. They were desperately trying to save a man who came in with a GI bleed. He didn't make it.

You are of course right about STAT getting a response. When I was still fairly new I didn't know the weight that uttering the word STAT in a medical environment carries. One day, I needed something from someone and timing was important and I couldn't locate them. So...I had them paged STAT to my extension. The next thing I know the house supervisor comes running in breathless and wide eyed wanting to know what was wrong. I told her nothing serious but that I needed this person for something. She kind of half grinned and said "You NEVER use STAT unless it is an emergency." And I never did again after that. :)

Your SWIT PDQ regarding STAT was interesting. You may want to check out my TPC post if you like cinnamon and spices baked goods. I posted my Thanksgiving Pumpkin Cookies recipe that seems to be really popular with people. I will also be baking these Sunday to bring in to my urodoc's office on Monday as they told me they really liked them last year.

Happy Thanksgiving!

P.S. I find down time in front of the computer, especially with the blogs to be so relaxing. You know how with alcohol (2nd sip for me) you get that ahhhhh feeling when it hits, well for me just coming into the blogosphere does that. If I were still doing 3-11's I would definitely blog when I got home because I NEVER was able to just go to sleep after working there.

Sorry I deleted twice now - that bloggers remorse thing I get every now and then :)

SeaSpray said...

I have a question I have always wondered but never ask. I realize there are different variables but surgeons being human (you are right? ;) ) I would still think it comes down to the same need sleep.

As in Chinese Pager Torture PCP's get woken up but it seems that surgeons have to go into the hospital. It also seems that you could spend a nite on call at the hospital and then still have to go to work the next day. Dr Keagirl has mentioned it in Urostream and others that I am forgetting now but she has never discussed the consequences, just the annoyance of being called in for someone she called "Needle Dick" because on a meth craze he shoved 35 (or less) needles up his schwing schwang. She has since removed that post because she was concerned that one was potentially identifiable. Ha! I think she even blasted her husband after being called to go in because of something a male pt had done...wanting to know what it was about men anyway..etc.,etc,. (very funny)

I really want to know how you do it because you still need sleep. How DO you function the next day? Are you at the very least "cranky" the next day (I think I would be) or does it ever impair judgment? I am saying you but I really mean docs in general. For surgeons is it because you trained in a tough residency where surgeons eat their young (heard that on another blog describing a surgical residency from someone who didn't like it)and if you can't get through the rigors of a surgical residency then you can't cut it as a surgeon? Just wondering how y'all cope? Also give y'all a lot of credit and respect because not everyone could do it...that is for sure.

If you don't feel like answering it would also make for an interesting post. I think it was in Dr Schwab's burnout post that he discussed that if he had a weekend on call...he STILL couldn't relax because he was always waiting for the phone to ring.

SnowLite said...

BTW-I hope I wasn't offensive in suggesting you could be cranky or have impaired judgment when sleep deprived. It's just that I have wondered how you all do it. And you all have so much responsibilities on all fronts...but you are only human. And you could work all day, take call (do surgery) busy all night and still have to work next day. Surgical residency must be AKA for Superman School. :)

I consider myself to be an easygoing,fun loving,free spirited, forgiving, and kind person. However, there are 2 things that can break me real quick- SLEEP DEPRIVATION and HEAT (too dry-too humid doesn't matter)because I will be miserable and therefore a little testy if tired (not to strangers but the ones I am around a lot)and if too hot throw whiny in the mix. And I don't have the responsibilities that you all do.

Oh and I recently discovered a third thing that will make me snap but I think I will save that for a SeaSpray or SnowLite post. Suffice it to know I snapped at my urodoc and when I thought about it later I was dying a thousand deaths because I would never snap at him.

Chrysalis Angel said...

How true. We could always tell how bad something was on a scene by the voices on the radio. They may remain professional on the air, but you can still hear that tension in their voices.