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