IN THE STRETCHER INSTEAD OF BESIDE IT

Welcome to my first blog post, otherwise known as The Space for a Longtime Repressed Writer. I approached our editors about writing some sort of “human interest/lessons learned” blog to complement the multitude of great educational posts and interesting ED cases in TOKC, sort of allowing your mind to “take a break” for a few minutes while you read, and hopefully gain a little perspective on life in the ED and medicine, and maybe even life in general. As most of you know I’ve never been afraid to share my experiences, not only about patients and cases in the ED, but also about being sued, being in court, matrimonial woes, and raising kids with disabilities, amongst other things. I hope to bring you in my blog at least a minute in your busy day to think, reflect, laugh or smile. Please give me feedback on the writings and feel free to suggest topics too. Hope you enjoy, and off we go…

by Dr. Michael Lanigan

I recently had surgery to remove a tumor in my neck (benign fortunately). It turned out to be a fairly routine operation. While primarily I am relieved and satisfied that all went according to plan and recovery has been uneventful so far, I ended up seeing this experience as something more – as my chance to see what our own patients encounter in the ED. Yes, I was in the Ambulatory Surgery Dept. and the OR, understandably different environments than our busy and sometimes chaotic ED. However, I was asked to go through some of the routines that our ED patients do:

—I was asked to strip completely naked and put a gown on behind a closed curtain in the Amb Surg area (but at least I was given the opportunity to close the curtain).

—I waited for what seemed like a long time before the nurse, registrar, and eventually the surgeons and anesthesia team arrived. I passed the time watching a woman do laps with her young child around Amb Surg. Cute kid she was, but not exactly getting me closer to surgery. Now imagine you are waiting in the ED, scared, because you think you have a potentially life-threatening condition. You sit alone, waiting, fearing the worst and not knowing the plan.

—It was clear to me, being a physician, that a nurse anesthetist was going to do my anesthesia and a resident would be in on my surgery. I was satisfied both would be adequately supervised during the case, but I wondered if all of our patients feel at ease with all of the providers they meet in the ED. Are they OK being treated by residents? Or medical students?

—EVERYONE who I encountered smiled, introduced themselves and seemed genuinely interested in any questions or concerns I had. I’d like to think we all do that with every single patient we see in the ED, but….

—The informed consent was thoroughly reviewed with me and all potential issues were addressed. We reviewed my CT one more time, my surgical site was marked (“right side, right patient”), and I was walked through the steps of the operation, including the wound closure. Their professionalism made me feel safer.

—My SO was allowed to stay with me until I went back to the OR. My surgeon even went to the waiting room and brought her to my stretcher when I was in Recovery so that she could hear the post-op instructions also in case I was still in a fog (which I was). We chase family out of the ED all the time and are even sometimes glad when they are gone so we can “do our job.”

Now, I can hear you guys already…”Lanigan, come on, get real! What you went through is COMPLETELY different than the patients, the pace and the challenges presented in our ED.”

Maybe that’s a problem….

Look, we can’t choose who comes through our doors…patients, families, EMS; any of whom are capable of bringing a negative dynamic to our day. However, I contend that the very large majority of our ED patients just want what I wanted: to have pleasant health care providers treat me with respect, to take an extra minute or two to review or explain anything that needs clarification, and to apply their learned and acquired skills the best they can to help me get better, and involve anyone else in my care that will help me reach my wellness goals.

So…next time you are going in “mind fry” or are thinking about what you’re going to get at the Deli or where the post-shift drinks will be tonight…put a smile on your face before you introduce yourself to your next patient, ask the patient if he/she has any concerns that you can answer, and do your very best to convince the patient and their family/companion that their medical concern is the most important thing to you at that moment in time, because take it from this PGY-21, when I had my turn in the stretcher, those things mattered.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital