Just another day
2022; Wiley; Volume: 29; Issue: 10 Linguagem: Inglês
10.1111/acem.14538
ISSN1553-2712
Autores ResumoThe day starts like any other. I roll in at 6 AM to take sign-out from the overnight team who sport purple bags under their eyes. The board is fairly clean. Nobody is too sick, mostly stable abdominal and chest pain work-ups and a few psych holds pending placement. “Follow up on bed 16s scan, repeat a CK on 20 once he gets his fluids, I'll page surgery after sign-out and circle back, etc., etc.” Just another day. The morning is calm, I sip coffee at my desk when I'm not roaming from room to room, pushing on bellies, palpating pulses, probing wounds…. Soon, I get a call on my phone: “EMS is bringing in a full code in 5.” I head up to the resus bay. Just another day, I think to myself. The medics arrive and give report: 24-year-old at a detox facility, witnessed seizure-like activity and emesis, then went unresponsive. Received bystander CPR. PEA and asystole at each pulse check, three rounds of epi prior to arrival. Our team goes to work. Pulse check: PEA, back on the chest. Another epi please, bicarb, calcium. Pulse check: PEA, back on the chest. ET tube in place, positive end-tidal. No pneumo on ultrasound. Pulse check: asystole, back on the chest. Another round of epi. No pericardial effusion. End tidal is dropping. After rounds and rounds of compressions, my H's and T's fail me. “Does anyone have any other ideas?” I announce to the room. I receive silence in return. Pulse check: “Time of death: 9:15 AM.” Just another day, I tell myself. “Let's have a moment of silence…” Her mother shows up later that morning. I deliver the news. She looks back at me stone-faced. “I was expecting this,” she says. The patient had a long history of mental health and substance abuse problems, not uncommon at our safety-net hospital. It's only toward the end of our conversation when she shows any emotion, choking back tears “At least I can tell her children that their mother was good and that she went to heaven.” Just another day, I think to myself. Dejected, I leave as the social worker directs her to the morgue. I pick up the next chart: Ear pain. I scrape out a large ball of cerumen and try to recall the Spanish word for earwax. “Ahhh,” she sighs in relief, “Muchas gracias, muy amable.” From there on, my shift is smooth sailing. I reassure a “GI bleed” that their hemorrhoids are nothing to fret over. I win a wager on a D-Dimer and send the patient home, both of us in good spirits. Hopping over to fast track, I clinch the diagnosis of mallet finger, splint in extension, and move along. Just another day, I think, cheering myself on. Some days it's the little victories that outweigh the big defeats. “The nurse will bring you your paperwork, then you're good to go.” Not the first time I've said it, and certainly not the last. “And don't forget to make an appointment with your primary doc!” I add as I close the curtain behind me. I head back to my computer, hit the discharge button, and check the clock. 2:02 PM, I've crossed the finish line, no more patients this shift. As the evening shift crew trickles in I update my patients on their results, catch up on notes, and clean up my dispos for sign-out. Just another day, I think to myself. Except today is different. After 3 years in the trenches, today is my last shift at the county emergency department, my home base. Of course there are 2 months of residency left, but I'll be off-service, working at outside community hospitals, one more month in the MICU and another in the ED. I hand over my patients. I have not told my colleagues, my friends, that today is my last. Given the timing they do not realize it, and it just does not feel right to tell them. Why make a fuss? It really is just another day, I convince myself. I hand in my phone in exchange for car keys and walk out the ambulance doors into the bright afternoon sun. I look back and contemplate the hospital and the people inside it who helped form me into the physician I am. I've worked hundreds of shifts and taken care of thousands of patients, but in this job there's always another patient, always another shift, always another turnover. The cycle goes on. Today, like every other day, was just another day.
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