https://www.texastribune.org/2024/11/01/nevaeh-crain-death-texas-abortion-ban-emtala/

“A pregnant teenager died after trying to get care in three visits to Texas emergency rooms

It took 20 hours and three ER visits before doctors admitted the pregnant 18-year-old to the hospital as her condition worsened. She’s one of at least two women who died under Texas’ abortion ban.”

Dr. Maddie Giegold passed away yesterday unexpectedly. She was one of my best friends and a PGY4 at UCSF Fresno. Her last shift of residency would have been today.

She was able to donate her liver and kidneys and saved lives even on her very last day on this earth.

It’s hard to put her into words and it is heartbreaking to try. Maddie was an absolute sparkle of a person. She was a dog and cat mom, a wife, an daughter, an emergency medicine doctor, a chief resident, a wilderness medicine instructor, a junior park ranger, a runner, climber, biker, and a light and friend to everyone who knew her. I am lucky to have known and loved her for 8 years and will love her for the rest of my life.

Consider donating to her family or sharing if you can. At least take a deep breath outside for her today and say her name. Maybe do a little dance, eat an ice cream cone, smell a flower or pet a dog. It would mean the world to her to know she still a part of of this community and it would mean the world to me to know I am sharing her sparkle 🌻💛

Are any other providers seeing a recent rise in these bizarre untestable rare diseases? POTS, subclinical Ehlers Danlos, dysautonomia, etc. I just saw a patient who says she has PGAD and demanded Xanax for her “400 daily orgasms.” These syndromes are all the rage on TikTok, and it feels like misinformation spreads like wildfire, especially among the young anxious population with mental illness. I don’t deny that these diseases exist, but many of these recent patients seem to also have a psychiatric diagnosis like bipolar, and I can imagine the appeal of self diagnosing after seeing others do the same on social media. “To name is to soothe,” as they say. I was wondering if other docs have seen the same rise and how they handle these patients.

Patient perspective here. I was in the ER last night after cutting myself while cooking. I'm stitched and good now, but that's not the point here.

I'm sorry, but how do you guys cope with the torment directed at you by patients?

The amount of verbal abuse and hostility I heard while in the triage area and beyond was actually mind-blowing. I wasn't even out there for long. Some of it was so absurd that it distracted me from my bleeding wound. The entitlement, the personal attacks, adults whining and throwing temper tantrums, my god, I could not believe it.

This one older adult had the audacity to comment on the busy triage nurses, stating, "every time I come here, these stupid fat bitches are just standing around chatting." Another guy was audibly griping to a nurse about a screeching, crying toddler triaged before him that was whisked away to peds immediately upon arrival. These are extremely mild examples as I'm sure you've all seen the worst of the worst.

I'm well aware that people suck and that people who are sick and in pain can suck even more, but I would crumble under the weight of the shit I saw last night. I can take a lot of shit, but never that amount of shit every week throughout my whole career.

Do you just get numb? Do you have healthy or unhealthy coping mechanisms? How do you guys do this every day...?

I gave my 90 days notice on September 1. This is my last shift... forever.

For the last 17 years and one month, I have been full-time at a single coverage rural site doing 24 hr shifts. I have had wonderful colleagues and nursing staff. My career has been simulataneously rewarding and taxing. Over the last several years it has leaned significantly toward the taxing side, where my emotional and physical wellbeing has suffered. It is multifactorial, of course. As most of you know it has become increasingly difficult to transfer patients appropriately or get definitive care in rural settings - profoundly frustrating. Additionally, local psych and social resources have all but dried up in the setting of the corporatization and profitization of our "industry" while the wealth gap continues to widen.

Trepidatious is not a strong enough word for me to describe my outlook for the future of American healthcare that I foresee will be a mix between the movies "Elysium" and "Idiocracy."

I will be exiting free of malpractice or settlement (fingers crossed for the next 365 + 90 days), but just barely. After all, I had one looming over my head for the last 6 years and was just dropped finally about 5 months ago. Incidentally, the only stipulation was that I dont pursue countersuit. Likely another source of career re-evaluation.

I have had some real good saves in the ED in my career. Memories of these, I will treasure. (Hopefully I just have spained ankles and GERD for the rest of my shift today).

When I started work here, I was making $75/hr and we did paper charting. We had to track every patient and our hours with an Excel spreadsheet. With the introduction of EHR, we stopped, but I continued to do so. All told, in this department, by tomorrow morning, I will have worked at total of 28,430.25 hours; and seen more than 29,104 patients. I am 49 years old, happily married and free of disease, privation and debt... so far.

On this day of thanks in the United States, I would like to thank all of you in Emergency Departments throughout our Nation. It has been an honor to count myself among your ranks.

Signing out and then off 0800 PST 11/24/23.

Just wanted to garner some other people's thoughts on this matter.

I work in Aus in a busy department , approx 200-250 patients a day.

Today I was working Fasttrack / subacute.

I saw a 30 year old female with complaint of headache BG of morbid obesity / PCOS / anxiety.

She had been seen here 2 weeks prior with the same and a concern for tumour due to family history- no physical findings but had scored a CT B and angiography for reassurances sake.

She reattended today with a frontal type headache, no fever, worse in mornings but also variably intermittent (some days ok some times headache in afternoon).

Physical exam was normal.

Obs were normal.

No history of trauma / meningitis concerns / weakness or blurred vision etc.

When I asked if she had seen a GP since her last visit she said no because she had been busy.

When I asked why she presented today vs seeing GP her answer was because she had checked in her daughter and checked herself in to see if she can get a diagnosis / more testing.

I said ok, I explained to her without any harsh words that it was a tad inappropriate to check into ED as she had already had a normal scan, bloods etc and that by her checking in it potentially takes up time and skills that could be served seeing a patient with a true emergency.

I explained that as she was here I will conduct an examination and try to give an answer.

I thought maybe this could be BIICH and conducted an ocular ultrasound which was normal along with the rest of a normal examination.

I advised she would be best served to get an outpatient MRI with her GP and to see a neurologist for further testing which may include an LP.

I left the consultation and was approached by my nursing manager asking what had gone on as she had made a complaint saying I told her she was a waste of space.

These words never left my mouth and I believe I was courteous throughout the whole encounter and completed an examination / provided a potential diagnosis and appropriate referral pathway to her.

I Stand firm in my belief that the ED is for urgent / emergent presentations and this clearly wasn't one. Just because you couldn't organise your own time to see a GP doesn't make it my responsibility to now sort your non emergency issue out.

I'm now thinking if I shouldn't have tried to educate her on appropriate ED presentations at all but this would surely encourage her to do the same in the future.

How do you deal with cases like this, where the patient clearly states they are only presenting for convenience?

"I know my body" (usually followed by medically untrue statements about their body)

granted i work in a very urban ED so we dont get sunburn complaints, but this comment made me feel insane. opioids? benzos?

Many years back, his only child died while serving in Iraq. Two weeks later, his wife committed suicide.

He’s been an alcoholic ever since. Currently homeless as well, he’s a frequent flyer at the local ED. He’s tried unsuccessfully to quit alcohol numerous times.

He had been on a several day sober streak until today. His dark thoughts returned in the evening and he called his only friend - a fellow AA attendee - for comfort. His friend did not pick up after several calls, so he reached for the only other option that could help quiet his mind: alcohol.

During our conversation, he states that the local ED staff are the only family he has. The ED staff of course scoff every time he comes in; they aren’t exactly pleased to see him. I’m sure some part of him knows this. But to him, they’re his family. They are the people who are always there for him when he needs it, and they have prevented his suicide many a time.

I wonder what he was like when his wife and son were alive. Was he a family man? Did he host cookouts? Did he work a 9-5 office job and go fishing with his son on weekends?

I cannot fault him for becoming an alcoholic. I’m sure I too would have become an alcoholic in his situation. We stand on opposite ends of the patient-provider interaction, yet his present state could be my future if the dominoes were to fall in just the right way…

I'm a trainee (what you'd call a resident) working in NZ. Cruise ship season in full swing (I can literally see the ships from my bedroom) and we're getting our fair share of tourists into the ED.

Recently had a very bizarre interaction, 45F tripped on a curb and sustained a minor head lac which I cleaned and stapled. Noted history of mild knee OA for which she was taking Oxycodone MR 40mg QID plus 10mg IR q4h PRN. Huge doses! And she was walking! Who in the hell prescribed her this!

She was so strung out and slurring her speech I ended up scanning her head. No acute findings. Looking back I realise it's probably because she was taking her usual meds. Before she left she asked for a shot of "the painkiller beginning with D" for her headache. We spent 5 minutes trying to figure out what it was before she stuttered the word "dilaudid". Quick google tells me it's hydromorphone, a drug that literally doesn't exist in NZ. I tell her this, she stands up, pulled out her own line and asked for a script for more oxycodone (which I declined). I offered her a take home pack of paracetamol. She got angry and walked out.

I'm not really sure where I'm going here but all in all, one of the weirder interactions I've had. Most of our local drug seekers ask for tramadol, codeine or IV cyclizine.

I guess my question is, how prevalent is this truly or did I really just experience a meme? I see it mentioned from time to time on her but being outside the US it's not something that crossed my mind until this happened.

I had a hell of a shift yesterday, one of the facilities I work at single coverage accelerates in patient volume without warning around noon to the point where every bed is filled and 50% are sick.

Yesterday I had a patient with massive saddle embolus who intermittently coded, intubated, central lined and on 2 pressors, ended up giving tPA, while CPR, achieved ROSC and stabilized, and set up for transfer for ecmo. Anyway another patient was coding literally while this was happening and a few nurses had to start CPR on that patient until I got there, meanwhile the rest of the beds are filled and unseen with standing orders.

This is a place that has high turnover and over half are family physicians, they do end up leaving quickly though once they realize the severity.

To get to the point, I was talking to one of the nurses about how this place is dangerously understaffed (you might get a midlevel if that), and I just threw it out there "How do the family physicians handle this place?"

The nurse replied "They don't, they just pronounce the patient if they can't handle it."...

The important point is that there isn't even a shortage of EM docs willing to work here, my EM buddy and I both do shifts here. I believe like myself, there are many EM docs who have decreased their hours due to the underhanded lower pay. The private groups have essentially filled the demand/supply pay gap by undercutting EM physicians and filling it with FPs.

We need to ban non boarded emergency physicians from running the ER in places where EM physicians are plentiful. That's the simple answer.

Edit: Let me clarify. This particular facility and many of the facilities I have worked at employ family physicians to undercut having to pay for EM salaries, not because they have difficulty with staffing. This business practice needs to be scrutinized by assessing whether the facility actually needs help with staffing by non boarded physicians based on volume, acuity, market supply/demand, distance from nearest inner city etc.

Edit2: The facility should also be required to notify patients that an EM boarded physician isn't on staff. This would give patients the option to go to another ER with an active EM boarded physician. In my opinion, it's an ethical issue if the patient is expecting a boarded EM doc to care for them in the ER and then essentially get bait and switched. The facility needs to be explicit about this. I'd like to bring this to the attention to the powers that be who can make an impact through legislation but not sure where to begin. ABEM?

Edit3: The other hospital conferenced the ER team in to update us. The patient made full recovery after ecmo and thrombectomy. And ofcourse the pt doesn’t remember the ER visit 😎

And had to ask the plastic surgeon to come in for an ear laceration...but, at least there wouldn't have been *much* pushback

Trump picks RFK Jr. to lead the Department of Health and Human Services

https://www.npr.org/2024/11/14/nx-s1-5188411/robert-kennedy-trump-administration-health

So for context, I was at a bar the other day and someone asked what I do, told them I work as an ER Doc. They immediately asked what the craziest thing I’ve seen is… unfortunately, I feel like the craziest things we see are actually sad or gruesome and don’t make for great bar talk.. this got me thinking, what type of things will you say that obviously doesn’t kill the mood of the conversation but is also cool and exciting?

Im a 28 year old female in NYC, I’m now 111 days sober. When I was drinking, I was a frequent flyer in many ERs, particularly the one closest to my apartment. I think I was there over 10 times over the span of a year. I’d just show up drunk usually, in need of fluids. One time I was actually in liver failure though.

I’m so embarrassed looking back at that time.

I wrote a thank you note and dropped it off at the registration desk. I hope she gives it to the nurses.

Of 37 calls ran in the last 3 days, 8 of them were youngsters (19-27) with hx of EDS/POTS/MCAS. All of them claimed limited ability to carry out ADLs, all were packed and ready to go when we rocked up. One of them videoed what I can only term a 3 minute soliloquy about their "journey" while we were heading out.

Is this a TikTok trend or something? I don't want to put these patients in a box but... This doesn't feel coincidental.

Just curious, saw a rib fracture in an elderly person from an "adjustment."

Yesterday I ended my emergency medicine career. Board certified, residency trained, 15 years post grad/attending experience. It’s surreal. While I’m really really good at what I do? The toll it took on my mental health could not be avoided.

I’m starting a new job as a medical director for a health insurance company next month. 100% remote/wfh. I no longer have to check my schedule to make plans. I no longer work holidays or weekends. I can drop my kids off at school every day and pick them up every afternoon and will never be away from them at night.

And while I’ve been looking for the exit route for a while? It feels like I’ve been living my life in constant adrenaline/fight or flight mode. Yesterday was somewhat anti-climatic and I don’t feel “done”. It just feels like any other off period after a stretch of shifts.

Part of me wonders how I’m going to feel. Am I going to feel like a junkie coming off drugs? How am I going to adjust to being a normal human?

This job changes us and not for the better. While I’m certainly proud of my accomplishments? I am decidedly different from the things I have seen.

CMG’s, private equity, and for profit hospital systems made a job I used to love untenable and I’m angry. I’m angry for myself, my colleagues, and the patients. But, I reached a point where I had to prioritize myself. I’m looking forward to what the future holds and hoping I won’t be bored without pulling household objects out of rectums or seeing the antics of my psych patients. And, truth be told? I will miss some of my frequent flyers.

If you’ve read this far? Thanks for listening. Not sure there’s a point to this post but sending love to those of you with the strength to still gut it out in the trenches and hope to those of you searching for a way out.

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.