Patients are a Virtue

Being a patient is not easy.

In fact, it is darn right scary.

You have no idea what's going on and it's so easy to think the worse. Every feeling and symptom mimics the next and in turn makes your body feel like a open mine field.

Patients are bombarded with medical facts on the TV shows, commercials and Internet sites informing them just how VERY sick they are. I recently had a patient tell me that he checked an 'un-named' internet site, input his symptoms in the analysis box and was told his differential diagnosis included the Bubonic Plaque. OMG.....WTH? I would be scared tooo.

By nature we all want to be in some kind of control of our lives. Since I'm a type A personality, I truly understand that concept. It is normal for me to want to be in control of just about everything. As such, when I fly in airplanes or go blindly, I feel really uncomfortable. I think as doctors, we sometimes forget this.

But... if you get a doctor who has had to be a patient. One who has been on the receiving end of bad news or waited hours to be seen by a doctor...well by golly you have a changed man'.

I remember the first time I woke up from sleeping, couldn't feel my body and couldn't walk. Hearing the doctors say, "you may not be able to practice anymore and your hands and feet aren't going to be the same anymore.

I remember the first time I had to wait in a waiting room as a patient even though I was a doctor for hours. Only to receive what most folx' would classify as bad newz', but I was more upset that I sat for hours not knowing what was going on.

I remember the first time I felt unbearable pain that no medication could reduce. The thought that I may be on medication for the rest of my life......mmmmm...FOR LIFE? Are you serious?

When I take care of a patient, I pray that GOD will keep fresh in my memory what it's like to be on the receiving end.

Patients are nervous, worried and clueless. They respond in anger, nastiness, gratitude and denial. We as physicians have to be mindful of the patience needed when taking care of patients.

We must remember.....Patients are a Virtue.

"Don't look at my FEET"

*specific info/events have been changed to protect the patient and those involved in the care of this patient

A few weeks ago I was working my usual night shift schedule 7p - 7am. It was moving right along with nothing seemingly abnormal about it. The waiting room was exploding at its normal exponential growth multiplied by that unknown K-FACTOR (Karma) that increases the numbers at an extra fast quadruple rate. It happens every time I work. The typical myriad of patients were arriving all through the night and with all kinds of complaints.

You know.....I often wonder if the patients wait until I start my shift to come into the ED. I really think they sit around and say, "Hey, Dr. Warren should be in about right now, let me head on down there. In fact, let me call all my peeps so we all can go down together."

It's like the ED has a huge flashing Las Vegas sign that screams....

"DR WARREN is ON...DR WARREN is ON !!!"

Naw', I'm just kidding, but deep down I do wonder sometimes.... :-)

Anyway, as the clock approaches 2am, I get a medic control call (a call between the ED doc & ambulance/EMS via phone) that I'm getting a patient with a GSW (gunshot wound) to the back and they would be arriving in 5 minutes. The patient was awake, alert and vital signs were stable.

OK, so at this point, myself and the trauma team are setting up. We're preparing for anything that could possibly come through the door. We never know if the story given by medic control is correct or if some vital info has been left out. Nevertheless...we're READY.

Within 3 minutes, EMS comes in rolling a stretcher with a young girl screamin' and hollering. She was lying supine (on her back) and moving all four extremities (arms/legs). She could be no more than 15 years old. We can see the blood on the stretcher, but have not visually seen any wounds yet. As we try to stabilize the patient, we're becoming more concerned because we have no idea where there bullet is or where it has traveled, yet the young patient is jumping and squirming all around on the stretcher...

THOUGHTS....

1. ? Bullet moves into the spinal canal = paralysis
2. ? Bullet has transversed the body = internal damage ie. lung, kidney, intestines, etc
3. ? Bullet has hit a bone = fractured bones

We're worried. And as usual, I begin my calming approach to get the patient to relax. I know that even the slightest movements could move a bullet or worsen an injury or fracture. I wanted her to relax.
It was at that point that I realized that she wasn't screaming and hollering because of pain OR because she was just shot in the back at 2am on a school night.
She was screaming and moving around because,

" I DON'T WANT YALL' LOOKING AT MY FEET, MY FEET ARE UGLY".

"Listen baby, no one cares about your feet, we're worried about you. We need to make sure that you are ok. I don't want you to be paralyzed or bleeding inside where you could DIE."

"I don't care, yall' can't be lookin' at my feet. Please don't take my socks off. PLEASE, PLEASE !! My feet are UGLY."

I could not understand why her feet were so much more important than the thought of herself possibly dying. Your feet? Really? But then I thought about it...she's a young kid, scared to death and all she could do to ignore the shock of what just happened to her was to focus on her feet. She was serious about it too..nothing else seemed to bother her except those feet.

So I thought to myself putting aside the anger that was brewing and the stereo-typical thoughts that I KNEW all my comrades were thinking. She's still a kid.

"OK baby, if I get you some hospital socks and change them under the sheet so no one can see, will you please lie still and let us take care of you?"

"Yes".

So as the approved change was occurring, she quickly calmed down. Within minutes she became quiet and somber with a mousey' whimper. "I want my mommy! It hurts so bad. I just want my life back."

We completed our exam with ease and found she had some treatable injuries. She was admitted.

Even in the deepest of events....a kid will still be a kid...Don't look at my FEET !

INNER GUT Feeling

In my ten years working as a physician in the Emergency Room I have seen all kinds of patient cases. Cases ranging from a small blister on a finger to a full code with CPR in progress. Each patient interaction caries a certain level of comfort and familiarity just from the repetitive exposure of similar patients and from the teachings and guidance during our residency training.

Unfortunately, the one thing that you can only pray that you develop, that really CAN'T be taught is that....

"INNER GUT FEELING".

I teach residents and medical students during each clinical shift how to recognize and treat the different disease processes we might encounter. They learn to develop a comfort level with applying the basic ABC's of stabilizing the critical patient. So when the GI Bleeding patient who is vomiting bright red blood with a low blood pressure of 80/50 and heart rate of 140 (normal BP-120/60, HR-60-100) arrives in the ED, they immediately go into the step by step process of:

A-securing the airway,
B-making sure the patient is breathing,
C-improving the circulation ie. blood volume that has been lost.

It really is bread and butter application. Or maybe it's the patient that arrives breathing 40 breaths per minute (nml rate @12-19, diaphoretic (sweating all over) and barely sitting on the stretcher pulling hard to get air into their lungs because they're having a bad asthma attack, severe pneumonia or maybe their lungs are filling up with water (congestive heart failure). Again...ABC's are applied over and over.

See, these are the kind of cases that everybody watches on the TV shows where the ambulances are rushing VERY sick patients into the ED, everybody starts running into the room and moving at lightening speed to get the VERY sick patient stabilized. I guess I would have to admit that it really is intense as it appears on the TV shows. Adrenaline is rushing, folx' are nervous and the ABC's are kicking in. NO doubt you must appear as though you have it all together despite the chaos that is ensuing and the fact that you have the life of someone in your hands.

BUT...this is not the hard part in being an ER Doc. It's up there on the list of stressful causes but its not the hardest thing in being an ER Doc. This is the stuff we're taught to handle.
What can't be taught is that patient that comes into the ED with the non-threatening appearing complaint, laughing and talking with staff or family and within hours, sometimes minutes is DEAD.

How do you teach that to these new docs? Well, you really can't. You either have that INNER GUT Feeling or you don't. You have to have that small thorn in your side that keeps nagging you into a feeling that something is wrong. Often there are little sutle signs that can help us improve that feeling.

- Sometimes patients have a look like "I'm doing OK" but when you have that INNER GUT feeling, you actually see someone that looks sick as hell. I walk into the room after the resident has given me that "not-so-sick version" of the patients complaint and I finish my exam and think..This person is VERY SICK.

- "The open mouth sign". If I walk past a patient room and the patient is elderly, sleeping on the stretcher without movement AND the mouth is wide open...I get worried. Immediately, I move that patient up on my mental list of "sick patients".

- The altered patient who can't tell you whats going on...is always, always, VERY, VERY sick in my book until proven otherwise.

- Of course most of the credit for this feeling would have to go to GOD. I think HE literally puts that feeling in my spirit because I can't put my finger on why I have that "something just ain't right" energy.

Whatever the case may be, I PRAY that your doctor whether in the ER or in their private office has been blessed with that gift of an "INNER GUT Feeling".
It improves with time and experience, but it's not taught. It's inert and I can only hope that the new doctors that I train daily will recognize and LISTEN for that "INNER GUT Feeling".

ONLY in DA' HOOD !

Only in an emergency room in an inner city..often called "da hood" will you experience the unwritten exposures of a lifetime. Experiences that one could never make up. The kind of stuff that TV show producers wouldn't even think about.

"YOU BITCH !!!" "YOU BITCH !!!" I could count the many times that I was called that tonight. Actually, pretty much every night. But tonight I had the pleasure of enduring this abuse by the same female patient...WHY?

She came to the ED complaining of what seemed like an ordinary story of abdominal pain, flank pain (kidney area), urinary complaints with nausea and vomiting. She received the thorough physical exam including complete diagnostics that included labs and an abdominal Cat Scan to rule out a kidney stone. She was given morphine IV for pain and zofran IV for nausea. Hell she was given the works.

AND THEN...the CHANGE begins. A complete METAMORPHISIS... one that would shame even NEO from the Matrix.

The patient now needs more pain meds and additionally requests benadryl because "I always get benadryl 50mg IV (intravenously) with my pain medication". Then I find out that she is allergic to motrin, toradol and aspirin and the ONLY thing that works for her are those narcotic-kinda drugs. Go figure !
So after EVERY freakin' lab test is negative including her urine analysis and cat scan, I inform the patient that she is cleared for discharge.

HERE COMES THE QUESTION and the final stage of the transformation? ..... "Waccha' gonna give me for home for pain?"

I knew it, I knew it was coming. She was here for the abuse of pain medication. Reviewing her medical chart, I noticed she had had several visits in the last few months for similar complaints. Even one visit where she stated she had Sickle Cell Disease and requested dilaudid. Did she really think she was going to get over on me? Sista-gurl, I grew up in da' hood and I know da' hood.
So of course I attempted to explain that there is no reason for me to give her a narcotic prescription for a negative work up and that she should see her PMD (which she has one), but it was not turning out well. She began getting louder and louder at the point where she told everyone in the ED that I was refusing her pain medication and sending her home with NOTHING. Next came the "you F--ing B--tch", "you aint sh--", "you just like them other white doctors, you don't care", "you lucky I'm not blackin' out on you cuz I woulda fu--ed you up by now". So as she fully dresses, she is still entertaining the ED with her antics. And lets not forget that she also refuses to sign her discharge papers. She walks past me without difficulty and in no apparent painful distress and repeats, "YOU BITCH !!!", "YOU BITCH !!!", "YOU BITCH !!!"

And I just say, "Thank You and have a BLESSED DAY!"

ONLY IN DA HOOD!!!




* language may be abrasive and offensive at times on this video, but its true to life

It's JUST Not for YOU !

What makes us choose the different careers that we do?

Is it the big money that we assumed we would make? Is it the relaxed work hours that allow us to sleep until the late morning or is the ability to work at home all day and create our own cultural atmosphere? Could it even be because you felt like you would be doing something special that you were darn right born to do....

Well, whatever drives you into one career or another.......

SHOULD YOU NOT LIKE WHAT YOU DO?

I worked last weekend with several nurses with whom I had to lose my temper. I really hate to have tense relationships with nurses. It is truly a bad decision to go that way because they can MAKE or BREAK you. Hell, they're really the backbone behind every succesful care given to a patient. Plus I know that being an ER nurse is definately a challenge. It is high-paced, stressful and overwhelming. The pay is great and the hours are long working only 2-3 days a week @ 12hours/day. BUT guess what...you chose to do it, so why are you angry about your job duties?

Is it fair for a patient to wait 1 hour + after they have been written for discharge because you need to take your union break? Or for the 78-year old altered female lying in bed with a blood pressure 200/112 and you have yet to give the blood pressure medication ordered 2 hours ago. But what took me over the egde for the night was the spanish-speaking family who received english-printed discharge papers with no explanation or direction of what to do or expect. And to top it off, this same nurse pulled out the IV catheter on this patient and dropped it on the floor next to the patient. WTH?

When your job becomes something that iritates and aggravates you to a point where your performance suffers...It's JUST Not for YOU!

Do you wake up in the morning thinking of excuses of how to call out of work? Are you dreading every minute yet to come on the long drive (that's really only a few minutes) to work? It's JUST Not for YOU!

I remember way back when I was an Electrical Engineer working for General Motors (yes I had a life and a job before becoming a doctor) and I hated my job. It was that piercing kind-of-gut feeling that lets you know, "I gotta' get outta here". And I had that feeling every weekday morning upon waking. I couldn't wait for a day off whether I had to create it or not. (Of course that meant I was usually calling in sick if it wasn't a holiday.)

But you know, I was really sick...I was SICK and tired of that doggone job. It was psychologically killing me which in turn seemed to be manifesting physical weakness such as anger, impatience, and real "tiredness". I probably had more "out of work" days than I had productive days.

But why had I chosen this career? Why do you choose careers that are JUST Not for YOU?

Well for me, I enjoyed my challenging college classes of the EE world. I even made it into the Eta Kappa Nu honor society of electrical engineering. BUT I would have to say...it was more my Uncle, my Uncle Marvin who influenced my decision to be an engineer. Sure, I loved math and science...but quite frankly I saw a successful black man with a graduate degree in engineering LIVING LARGE..... He had a convertible mercedes, a convertible porsche, a house in the Colorado mountains as well as a summer home on the Virginia beach. He had everything that was equivalent to SUCCESS and I wanted it.

But what I realized the hard way and what most people fail to realize is that doing a job for success & money is the first step to failure. It is the next step downward toward unhappiness and contentment.

It is soo important that we choose careers that we ENJOY. Something you can wake up and be at least a little excited about heading out to do. It's even better if you can see yourself doing it for a long time...

So if your.... looking for excuses....feeling sick...treating folx' at work with a short & curt attitude...Take a look at your job...and maybe IT's JUST Not for YOU !

Palpatations 7/17/10

Well, It's Saturday night and I'm already thinking about my upcoming night shift in the ER tomorrow. 12 hours of pure bred CHAOS waiting for me on a platter with an apple in its' mouth. I can feel my heart racing like the galloping hoofs of a horse. My anxiety level is creeping up so fast that I begin to feel as if I'm the damsel in distress on the next "Nightmare on Elm Street" film. (By the way, what number movie are they on these days anyway, 25)

WHY?

Why is it that every week my body does this same pattern of fight or flight without fail. I mean, I literally have more than 24 hours to go before I actually step into another episode of the "Twilight Zone", yet I feel like my shift is starting any minute.
Now don't get me wrong....I do love what I do and I feel honored to treat the population I serve, but my chest wall is doing the beat box right now and I would guess that if anyone had a stethoscope to my heart, I could give Dougie Fresh a good battle. (He was the baddest beat box MC back in da' day..like in the 80's)

Working in the ER is nothing that can be explained in words. It's an experience that can only be summed up in the common phrases, "you gotta be in it, to win it" or "it's an ER thing, you wouldn't understand" (that's for all my HBCU grads).
It is a hybrid beast of its own not found in any animal encyclopedia. It can not be tamed, nor will it allow you to place a leash around its neck. The roar from its mouth could scare even the biggest Lion from the animal kingdom. So why do I keep trying to whip this beast into becoming the star of my one-woman circus show?

Folx' say all the time that they want to do something that makes a difference in someones life. And quite frankly, there are over a trillion ways to do that. Yet I chose a career that allows me that opportunity, but brings along with it a high-level of stress that I'm sure my own doctor would say could be a threat to my well-being.

NORMAL Heart Rate= 60 - 100 beats per minute

Soooo, here comes the stress...
The ER culture is not only fast-paced, but it requires you to think, function and perform within a blurs moment. It wants you to be a miracle worker and a magician all in one.
Heart Rate=105 bpm

The sounds of the ER are choreographed to a fine tune to keep your hips moving and groovin'. Tunes whose only purpose is to raise your anxiety just one more notch on that scale that seems to have no end. They include the melodic screams of the intoxicated patient, the ear-piercing beeps of a monitor being ignored by an overworked nurse, the soothing sounds of the dramatically retching patient (there is always more than one person vomiting at the same time)...to the audible criticisms of angry patients on how bad a job we are doing with our wait times.
Heart Rate=115 bpm

There's the days when 80% of my patients are 'sick as a dog' and I feel like I just can't see another patient without making some kind of a disastrous decision. I'm drained, I'm hungry and I'm weak, yet 5 more ambulance just wheeled in more patients needing to be seen immediately and the waiting room still has 25 people in it at 2am. (of course there were 50 people in the waiting room when my shift first started at 7pm)
Heart Rate=145 bpm

So by now, as I contemplate treating myself with a one-time dose of adenosine to slow down this supraventricular tachycardia (i.e. VERY fast heart beat) that my heart is beating at, I get the case that trumps it all. I finally get the rock that crushes the scissors. I get the opportunity to turn someones frown or worst fear into a smile. I get to teach my patient about their body and nutrition and turn them into good health soldier. I get to treat patients who are on the brink of respiratory arrest (stop breathing) or on the brink of "something BAD" improve into patients that say, "Thank you sooo much Doc.", "Can I get your card?", "Where is your office located?" in just a matter of minutes. I get to pray with families and patients during the most vulnerable times of their lives and turn their despair into hope.

So, as I anticipate the drama yet to come on my shift tomorrow night, as my heart rate is ramping up by the hour, I know I will make a difference in someones life, change a hardened heart or even provide food and shelter to a homeless person. BUT most of all.............I will fulfill GOD's calling on my LIFE..
Heart Rate=75 bpm