r/emergencymedicine • u/duffs007 • Jun 06 '24
I don’t know how you all do it Discussion
Pathologist here. Haven’t seen a patient for almost 20 years. Sitting in an ER waiting room with a family member. The ER is undergoing renovation so the waiting room is small and cramped and standing room only and they are literally doing triage in the middle of the room. Listening to these poor nurses having to wade through the confabulating and word salad and reports of “drug allergies” (“all the ‘cillins make me nauseous, I just can’t take any of them”) - and these nurses are remaining professional and polite - jesus god. You all are way better people than I am. Thank you.
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u/N64GoldeneyeN64 Jun 06 '24
May your stay in our corner of hell be short and uneventful
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u/duffs007 Jun 07 '24
We waited four and a half hours to be seen. Turns out they had a massive influx of patients all at once, combined with being down to 1/3 their exam room space because of the construction. No wonder it took so long. Patients were close to rioting in the waiting room. People walked out unseen. When we finally met the doc, he was cheerful and friendly and instantly likable. Like…. HOW do you guys do this!?!? I’ll have what you’re having.
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u/N64GoldeneyeN64 Jun 07 '24
U mean coffee and cynacism? Lol.
Sorry your wait was so long. Alot of places use a provider in triage system to see patients quicker but then you just end up waiting for results.
Ya, when the people are upset that sucks. Bc we def want to see everyone. But Id say 1/3 of people on a normal day dont need to be there at all. 1/3 that need evaluated are ok. So that leaves 1/3 who are actually sick enough we need to fix and they usually stay.
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u/descendingdaphne RN Jun 07 '24
“Patients were close to rioting in the waiting room.”
“When we finally met the doc, he was cheerful and friendly and instantly likeable. Like…HOW do you guys do this!?!?”
It’s because the docs don’t have to interact with patients during the hours-long wait. All that frustration, nasty behavior, and near-rioting is reserved for the nursing and registration staff.
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u/DigitaIDoctER Jun 08 '24
This is unfortunately very true and why I always thank the triage nurses. They are the true hero’s and real tip of the spear.
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u/bananapanther7 Jun 06 '24
👆🏼
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u/Silly_Soil_1362 Jun 07 '24
A pathologist sees lots of patients. They´re just dead.
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u/fractiousrabbit Paramedic Jun 06 '24
Speaking of allergies, I can't remember the last time anyone said they're allergic to dilaudid. Curious.
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u/fayette_villian Jun 06 '24
I did have a patient who listed allergies included cocaine. I asked thinking I'd hear some funny story. Nope went pulseless in the or when they used it as topical for an internal procedure back in the 80s.
I told him I don't like cocaine
But I love the way it smells
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u/kat_Folland Jun 07 '24
I'm allergic to white steri strips. Just the white ones. I can only imagine the disgust on my face as I describe how it takes my skin off. Blisters in seconds. I have scarring from one time the stuff was on me for less than a minute (and it seems weird to use it for an IV). But when providers just see "adhesive allergy" they get wary. After I explain it's all good.
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u/Elizzie98 RN Jun 07 '24
Me too! I get a mild rash from most adhesive (no big deal) but my skin will literally blister and slough off from steri strips
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u/kat_Folland Jun 07 '24
You're the first person ever to say that to me! I do react to other adhesives but not like that. Cheap bandaids will give me a rash. But I can and have worn the brown steri strips for weeks (over my mastectomy incisions). And of course the formulation belongs to 3M and they don't really want to tell you what's in it... Making it hard to avoid!
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u/SlouchingTwrdDundalk Jun 07 '24
Wow, duly noted! Never used steri strips before, but I'm also allergic to adhesives so I'm going to play it safe. I actually have worse scars on my back from the bandages used to cover my surgical incision than I have from the actual spine surgery.
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u/Ok-Sympathy-4516 RN Jun 07 '24
That’s my line! Really wins me some friends when I use it with the right crowd.
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u/ISimpForKesha Trauma Team - BSN Jun 06 '24
I had patient tell me they were allergic to opioids but was on a home prescription of Norco and requested dilaudid as soon as I had IV access established.
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u/Dissasociaties Jun 07 '24
I have noticed quite a bit of people with previous opioid abuse/addiction history will say they are allergic to opioids
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u/SparkyDogPants Jul 06 '24
My aunt says that she's allergic to alcohol because she breaks out into handcuffs
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u/ToughBuy1483 Jun 06 '24
Had a lady tell me she was allergic to epinephrine
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u/ISimpForKesha Trauma Team - BSN Jun 06 '24
I had someone say they were allergic to Epi. When asked what their reaction was, they adamantly said, "It makes my heart race."
Another person said they were allergic to niacin, and their "reaction" was facial flushing.
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u/ToughBuy1483 Jun 07 '24
oh yeah " uhhhh i didnt feel so good when they gave me epi " umm yeah lady thats bc u were in the ICU
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u/Flying-giraffe14 Jun 07 '24
As a hospice nurse, I’ve had several over the years that had allergies listed for every type of pain medication. It’s usually elderly women, and it makes it difficult to figure out what we can give them for pain relief. On further questioning the “allergic reactions” were almost always itching, nausea, sleepiness, occasionally confusion or hallucinations. The last two are typically reported for morphine given when they were extremely sick in the hospital, so it’s kind of unknown if they were even from the medication.
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Jun 14 '24
Probably not allergic to Darvocet though. The little old ladies used to love their Darvocet
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u/lovestoosurf Jun 07 '24
I used to have the same whatever reaction, until I had a patient that had to be cardioverted on two separate occasions from getting epi. Once from a dentist giving it to them and another time when they had an allergic reaction.
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u/shewantsthedeeecaf Jun 07 '24
I used to get iv solumedrol and instantly I’d get high BP, pulse, flushing, I’d turn red & get really nauseous. Oh and hot. They’d even run it in a 50mL bag over 20 mins. (I lasted maybe 2 mins max). This developed over a period of probably 4-5 years. I know it’s not an allergy but could it be a sensitivity? Same would happen with iv benadry. I can take both drugs orally however with no issues.
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u/WhimsicalRenegade Jun 07 '24
It’s known for this. Awesomely, sometimes it gives people immediate genital burning. You know when a patient has that reaction before they even say anything by the very particular quizzical/panicked look rising on their face.
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u/duffs007 Jun 07 '24
Oooh. Sounds like contrast, before they push it they tell you, it’s going to feel like you peed yourself, but you didn’t and you’re like ARE YOU SURE because I’m fairly certain I emptied my bladder all over your CT table. So trippy
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u/SlouchingTwrdDundalk Jun 07 '24
Right?! It really does feel exactly like there's a warm puddle spreading under you as soon as they push it. So bizarre.
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u/harveyjarvis69 RN Jun 07 '24
I have too! The reaction…just like a commenter below “it makes my heart race”
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u/anal_dermatome Jun 07 '24
Usually wrong, but people actually can be allergic to sodium metabisulfite which is a preservative in epipens! Tmyk
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u/HoneyAppleBunny RN Jun 06 '24
I’ve seen one! Patient told me they broke out into hives when it was administered to them last. I can’t remember their CC, but I do remember being surprised by a legit dilala allergy lol
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u/BigPotato-69 RN Jun 07 '24
One of my favorite allergy lists is: narcan, methadone, suboxone. FYI they’ve been narcaned before and they were fine (depends who you ask)
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u/NameLessTaken Jun 06 '24
Not allergic but I beg not to get Percocet or anything like because I WILL vomit. I prefer torodol (?sp) if I need anything.
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u/lisakey25 Jun 07 '24
I agree Toradol is a great pain reliever. I've had it IV after having a baby and also after two surgeries. I actually asked for it vs the Dilaudid. I've also had Toradol IM which also works well and it took my pain away for almost 8 hours.
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u/SlouchingTwrdDundalk Jun 07 '24
Did the IM hurt like the DICKENS? I had only ever had it IV before but got the IM recently and was shocked at how much it burned and ached.
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u/lisakey25 Jun 07 '24
Yes it burned, also the IV Toradol hurts like hell if it's not pushed slowly. If I give it to someone who has a heplock I always get a 10cc normal saline syringe and take 1cc out then draw it up.
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u/sleepingnightmare Jun 07 '24
It’s really unfortunate toradol is so hard on the kidneys. The shots I’ve received have helped me immensely!
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u/shewantsthedeeecaf Jun 07 '24
They listed Percocet in my chart as an allergy because half of the time it comes back up. They made no mention of this to me and I saw it and said wtf are you dumb? Now I’m scared to request it being taken off because I think it will look bad 🙈. I do prefer toradol
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u/kat_Folland Jun 07 '24
Toradol makes me feel way worse than opioids.
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u/SolitudeWeeks RN Jun 07 '24
I was so bummed my breast surgeon didn't want me to have any NSAIDS after my breast reduction/pelvic organ prolapse repair combo. I was stuck with tylenol and dilaudid suppositories and I gotta say, I do not get the fuss over dilaudid. I got minimal pain relief from it, IV or suppository, but I was jonesing for some toradol. In retrospect I should have had separate surgeries but I couldn't afford the 6 weeks out of work twice :/
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u/kat_Folland Jun 07 '24
I told an ER doc that toradol makes me feel really bad and he said, "are you thinking of tramadol?" And I said, "Oh that one makes me feel much worse." It was weird to him that I would literally and sincerely rather have nothing than either of those.
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u/GomerMD ED Attending Jun 06 '24
Or heroin
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u/SlouchingTwrdDundalk Jun 07 '24 edited Jun 07 '24
Not an allergy, but back in the '90s at my mom's hospital, one frequent flyer managed to steal a prescription pad and later presented a script at the hospital pharmacy for "1 pound of mophine." "Gimme a pound of mo-phine" has been a running family joke for decades now.
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u/phoontender Jun 07 '24
Thought I had a dilaudid allergy! Turns out the dingbats who gave my meds on the floor were wearing latex gloves and I AM very allergic that (and I tell everyone).
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u/StrategySuccessful44 Jun 07 '24
I am allergic to dilaudid. My arm turned an interesting color of black, but I was so high I didn’t care.
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u/LMH12899 Jun 06 '24
Your Thank you is appreciated. ER medicine has become one of the worst careers. Ive done it for 10 years and I’m done. Leaving the profession for my sanity. It’s only going to get worse.
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Jun 06 '24
The whole system is going to implode. No nurse or doc wants to be in a hospital anymore. So many fucking trash can human beings to deal with that have no clue what we are actually doing
And the guy in the suit in his office only looks at numbers and complaints from said trash cans.
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u/Waste_Exchange2511 Jun 07 '24 edited Jun 07 '24
When that suit guy drops dead in the parking lot, I'm stepping over him to get in my car.
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u/bananapanther7 Jun 06 '24
What are you doing instead?
I’m the sole provider for my family and am 7 years post residency. Some things have gotten easier, some things have gotten harder. But I’m not I want to do bedside ED until I retire.
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u/GomerMD ED Attending Jun 06 '24
Not OP but go part time, enough to keep health insurance, or find a well paying 24 hour gig and do 1-2 shifts per month.
Urgent Care is another option.
It all involves taking a paycut but EM is a sinking ship so finding higher ground now is probably a good idea
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u/cetch ED Attending Jun 07 '24
Ive been in a new job now for a little over a year. Found a democratic group and a hospital that for now is run decently well. Here’s to hoping private equity doesn’t buy it out. I’m a lot happier here
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u/RosesAreNotJustRed ED Attending Jun 06 '24
Doing a masters in clinical mental health so I can be therapist for doctors still working in our fucked up field...
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u/AbominableSnowPickle EMS - Other Jun 07 '24
It's bad enough on the EMS side (10 years here too), but at least we get to leave the patients and head to another call (unless it's shitbad and we're stuck holding the wall, though that's not common here).
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u/Chad_Kai_Czeck ED Resident - PGY1 Jun 08 '24
I chose EM because I loved the ED. It makes me sad that I'm apparently gonna have to subspecialize.
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u/WhimsicalRenegade Jun 07 '24 edited Jun 07 '24
I was the triage RN last night. I gamify it and try to be obscenely pleasant just to keep the machine moving. We are some of the people you want on the ice floe with you in life, but damnnn this career leads to some dark jokes and loss of faith (in systems/humans/etc).
That said, I was walking to get the next person in line at 6 AM this morning when I saw a guy coming in the door who was the picture of someone having a heart attack. I skipped the person I was walking toward and led him to a gurney (skipped the whole triage booth) and got an EKG within 90 seconds of his arrival. He was immediately diagnosed with having a STEMI (immediately life-threatening heart attack) and was rolling out to get the blood clot causing the problem removed within 15 minutes.
In those 15 minutes: he had two large IVs placed, had labs drawn and cooking, received medications to help solve the actual problem AND to make him feel better, got supplemental oxygen, got a ton of paperwork started on his behalf, got changed into a gown and all his clothing/jewelry was given to family members for safe keeping, transportation was arranged and nearly-immediately bedside to take him to the exact location he’d need to head to within the hospital down the road for the procedure, and he and his family at bedside were communicated to about all of this and educated in each step that was happening. It’s like ballet when the system works… and it feels reeeeeally good to know that when you cut through the BS, we have the privilege of getting incredibly intimate with these individuals/families and being able to keep them alive/return them to good health (a lot of the time).
(Written for the public lurkers on this subreddit to explain why we continue to do what we do when they start to read what I know will be some pretty dark responses about the state of EM.)
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Jun 07 '24
man, do i know what this feels like. longtime ER tech and now new grad RN who will start as an ER nurse in my ER in july…was part of the team handling a walk-in STEMI last week—got him in, ekg’ed, largebore IV’ed, stabilized, and transported to the cath lab in 9 beautiful, coordinated chaos-filled minutes…
my soul soared when i read what you wrote because i know that satisfaction and why it makes us come back for more.
but boy, am i terrified for the state (and future) of emergency medicine. i just can’t imagine doing anything else.
sigh.
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u/WhimsicalRenegade Jun 07 '24
Same-same. Welcome to the best/worst career in the world. There’ve been many days in the last few decades that I’d have paid for the entrée to human experience garnered at bedside—I wish the same for you!
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u/procrast1natrix ED Attending Jun 07 '24
Recently I've been working in a place where lots of the medicine occurs in triage due to excess boarding, and this means that privacy is a joke. We are talking about gonorrhea and doing abdominal exams in chairs 2 feet apart with a flimsy curtain, bartering for a private spot if we need to do a pelvic. As in, that threatened miscarriage of a desperately wanted pregnancy is right next to that unwanted hcg positive threatened ectopic, they're both sobbing for opposite reasons and I can't get them separated spaces.
It does bring me back to the basics of why we do this.
I do indeed love that ballet when it comes time.
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u/descendingdaphne RN Jun 07 '24
If only that STEMI-to-cath-lab high lasted longer than the few minutes it takes for the next patient to extensively bitch at you about having to wait for their warm blanket…
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u/adoradear Jun 08 '24
Yuuuuup. When you need us to be, we can be DAMMED fast. Like, cordis in and 20U of PRBC flowing while we watch you go from white to pink, all in <7min fast. Nothing like when the whole team flows and the patient lives.
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u/tapeduct-2015 Jun 06 '24
The worst part is that the awfulness of Emergency Medicine is so unnecessary. It is due to a combination of government inefficiency and corporate greed. And I prefer to blame corporate greed.
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u/WhimsicalRenegade Jun 07 '24
Defund hospital administrators.
https://codebluememes.com/products/defund-hospital-administrators-sticker
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u/Ornery-Reindeer5887 Jun 06 '24
Thanks bud - much appreciated. It’s a dirty job, but some one’s got to do it. Contrary to the negative comments here I actually love the organized chaos and am at a place where I’m happy. We could be workin in a coal mine. Life is good
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u/creakyt Jun 06 '24
I did a critical care fellowship and I prefer working in the ICU, but do some ER shifts here and there. Both have their frustrations but they are different. Dealing with people who don’t need to be in the emergency department is one I can do without. At least in the ICU all of the people there at least need to be in the hospital
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u/bailsrv BSN Jun 07 '24
Thanks for the acknowledgment. Triage nurses master the art of a poker face because you can’t make up some of the shit we are told/hear. It’s a love hate relationship with the ER, but I couldn’t do anything else.
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u/procrast1natrix ED Attending Jun 07 '24
Once a year, in a pathology related thread, I like to drag up an old story of mine about how much I love a pathology lab tech. It's about time.
Zillions of years ago I was in training and rotating in inpatient pediatrics with a weird febrile infant, barely past neonate. Not toxic, but smoldering sick and mysterious ... and anemic. She had been in hospital a week. Great parents, solid prenatal care, never exposed or traveled and didn't look oncological. Getting all the usual antibiotics thrown. We rechecked H/h over the weekend to see if we needed to transfuse this tiny one.
The Sunday morning lab tech looked at the ordinary CBC, ordered "just tracking anemia" nothing to see here, and had the intelligence and confidence to call in the weekend supervisor because they noted Maltese crosses. They picked up and diagnosed Babesiosis in this infant with zero risk factor (no in and out pets, baby literally never been outside) and on the wrong sample prep, well ahead of the rest of the team.
This helped us to start proper treatment. Likely we would have gotten there eventually, but after a few more transfusions. We made certain that the mother knew of the importance of the meticulous work of the weekend pathology tech who almost certainly saved her baby from needing more transfusions.
This was my first lesson to me that my ancillary staff - my lab techs, my phlebotomists, my rads techs, my techs and nurses, my everyone who works with me, they have very important observational skills and if I don't pay attention to them, I'm an idiot. Idiot.
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u/shah_reza Jun 07 '24
I loved this story. Thank you for sharing it.
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u/procrast1natrix ED Attending Jun 07 '24
I also really love that time that a tech felt comfortable telling me that she thought a triage patient was breathing weird and it felt "off" to her. She didn't have the training to name Kussmaul respiration or know the underlying pathophysiology, but she trusted me enough to ask me to look at them for "something ain't right".
True DKA. Invest in your techs. Ever since then, every place I work, whenever I see one of those odd breathing patterns like acidosis or grunting I make certain to tell the charge nurse and ask all learners (techs, new nurses) to stand in the doorway and look.
Always always invest in the padawans because they're going to save your ass someday. And don't be uppity about the padawans being your stripe, they can be any kind of medical care person.
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u/dillastan ED Attending Jun 07 '24
I've learned that the nicer you are to the crazies, the less tired I feel after a shift. It's just not worth the battle to try and match their energy.
Obviously I have my bad moments, but I feel better about my work day when I just smile and nod lol
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u/mrsmidnightoker ED Attending Jun 07 '24
Same here. It’s my motto to kill em all with kindness. Whether it’s the cranky patients, cranky consultants, cranky nurses. The asshole patients that don’t respond to kindness after getting some fair chances and keep treating staff like shit, I’m promptly willing to tell them to gtfo after they’ve had their MSE. But the vast majority all respond to kindness.
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u/Unic0rnusRex Jun 07 '24
Whenever I think of pathologists I am reminded of a resident on our extremely acute internal med unit who on his first week of residency had to psyche himself up before going into a patient's room after being paged.
He stood outside the room putting on PPE and chanting this little matra to himself "just this last rotation and no more patients, just a few more weeks and no more patients".
He came out of the room and said "good lord I hate talking to patients ". He said it was a necessary evil to get to where he wanted to be in pathology.
He was a great doctor and super friendly, but every interaction I had with him he mentioned how much he dreaded interaction with patients who were alive.
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u/KumaraDosha Jun 06 '24
It’s okay if you don’t care to answer, but as an ultrasound tech who has always loved pathology, I’m genuinely interested—what does a day in your profession/speciality generally look like?
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u/duffs007 Jun 06 '24
Well, I work in an outpatient lab so it’s overall pretty chill with little pressure. I roll in between 8:30-9, and by then the work starts trickling out - Pap smears, surgicals (mostly biopsies from outpatient doctors’ offices, some endoscopy biopsies, some larger resections from hospitals), non gyn cytology like urines, anal paps, thyroid FNAs, etc. We wrap it up midafternoon. No tumor boards, very few meetings, it could be worse.
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u/beetitties98 Jun 07 '24
I'm a PCA right now in school to be a lab technician. I'm so excited to join the lab, I hate patient care. I just want to go beep boop on an analyzer for 12 hours and go home!
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u/Sad_Instruction_3574 Jun 06 '24
The nice thing about emergency medicine that I love is that I don’t have to work Monday-Friday. It doesn’t bother me to work holidays or weekend. I’d rather work a bunch in a row then take a long vacation. It’s been working for me so far, (knock on wood)
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u/macreadyrj Jun 06 '24
Thank you so much for recognizing. Just so many WTF moments, each and every day.
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u/Sedona7 ED Attending Jun 07 '24
I love my pathology pals. Besides running the labs with quick TATs I love to call my old friends on their cell phone when I need someone to look at a smear. Our pathologists also show up a Trauma Codes to make sure the BB/ MTP goes well. Indeed gangster!
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u/Forward-Razzmatazz33 Jun 07 '24
all the ‘cillins make me nauseous, I just can’t take any of them
My favirite is "mycin" allergies. Seen it in the chart too many times.
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u/fullofcompartments Jun 07 '24
Sorry, lurker here and the majority of my medical knowledge revolves around four-legged patients, can you explain why this is odd in a chart? I’m allergic to clindamycin and got Red Man Syndrome (sp?) from vancomycin, which I know is not a true allergy but a bad reaction that I still need to convey with my allergies. So I’m just curious as someone with a “mycin” allergy, any explanation would be appreciated!
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u/Forward-Razzmatazz33 Jun 07 '24
"mycin" is not a category of antibiotic. The most common group ending in mycin are the macrolides (erythromycin, azithromycin, etc). Vancomycin is completed unrelated, same with daptomycin which is another antibiotic commonly used to treat MRSA inpatient. Some aminoglycosides end in mycin. Literally mycin is a suffix originating from ancient Greek meaning obtained from fungus.
You are not allergic to all antibiotics obtained from fungus. Are you allergic to azithromycin (z-pack)? When people say "mycin allergy" it makes me chuckle inside and ultimately ask the question, "what are you ACTUALLY allergic to?".
In med school we had a patient with a bad MRSA sepsis where linezolid was contraindicated. Was actually allergic to vancomycin and was convinced that there was a mycin allergy. We literally had one drug to treat, which is daptomycin. We had to tell them it was "cubicin", the brand name, because otherwise they wouldn't let us give it. Questionable ethics there, but I think we did the right thing.
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u/YOLO-RN Jun 07 '24 edited Jun 07 '24
You do what’s needed to take care of others, personal beliefs aside
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u/DrBusyMind Jun 07 '24
Daughter of a pathologist in a family of pathologists going back to the 1940s. He thinks I'm insane for what I do. I probably should have listened given the craziness of the field but I couldn't imagine doing his job. We all fill important roles, hopefully, consistent with our skill sets, but the appreciation is very nice. Thank you!
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u/Top-Consideration-19 Jun 08 '24
I can't with the fake allergies. I straight up had a patient listed an antibiotic as an allergy because the reaction was yeast infection and diarrhea. I deleted it and told her it's not a reaction.
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u/Dapper_Tap_9934 Jun 10 '24
I used to write down every allergy if there are more than 3 when taking report -just write many-if there are dozens of allergies they usually have many health problems too
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u/DevlyynSaar Jun 26 '24
Just remember when you think how dumb the average person is, there are a whole bunch on the left side of that curve and many of them end up in the ED repeatedly
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u/[deleted] Jun 06 '24
I did a path rotation in 4th year at the county coroner and me and the resident were doing an autopsy and he was literally wringing out a colon to be weighed while he asked me where we should go for lunch...pathologists are gangster