Hallway Four

In my hospital, Hallway Four is where the crazy people go. This is a glimpse of their lives and mine.

Thank You and Goodbye

Posted by Amy on January 14, 2008

I have been blogging for a long time.  A few years at least.  And I have always enjoyed the release of it – I have appreciated having a place to come with my stories, stresses, victories, shames.  A place where I’m (somewhat) anonymous and where the people who read my blog can identify with what I’m saying or going through.  It’s been so helpful as a new physician to have this place and I’ll always be thankful that I did. 

Yes, did.  I’m going to call it quits.  Nothing bad has happened that has led me to this point, it just seems like the longer I work in the ER, the less I have to say about my job.  I don’t know what this means.  I still have good cases and amazing patients and funny stories, but for some reason I feel less and less inclined to write about them now than I did a year ago. 

In a few months, I’ll be giving birth to my babies and I know that they alone will keep me far too busy to stay current with the blog.  In the meantime, I’ll continue to use my spare time researching strollers and reading parenting books.  I’m excited and ready to begin something new and look forward to all that awaits.

To the few of you who still check in regularly (despite my very-irregular writing!) thank you for keeping my numbers up and making me feel loved with your comments and presence.  There are so many great ER blogs out there that I know I won’t be missed by many, although I’ll certainly miss all of you and getting to feel like I have something worthwhile to say. 



Posted in The Medical Trenches | 30 Comments »

A last premonition

Posted by Amy on January 7, 2008

I recently had a 97 year old lady brought in by EMS with “shortness of breath”.  The telemetry call said she was breathing fast and becoming more and more hypoxic.  Apparently, she held out until she hit the doors to the ER, at which time she became apneic (not breathing) and pulseless.  Minutes later, we had her on the monitor and there was nothing but pacer spikes.  She was DNR and her daughters were at her side.  I checked for cardiac activity with the ultrasound machine, and, finding none (except a little blimp in the heart where the pacer kept firing) told the daughters she was dead. 

The daughters were upset, understandably, but also remarkably composed.  They said that their mother had lived a long, good life.  She had lived independently up until the week before and never lost her sharp mind.  One week prior, she had fallen and required hospitalization and then was discharged to a rehab facility.  She only spent 3 days there before presenting to the ER as my patient.  When I asked how she’d been over those last few days, the daughters said that she’d been eating less, but was otherwise okay.  But, earlier in the day she had said something to them that stuck in their minds.

One daughter was talking to the patient about how she would wash some of her clothes and bring them back for her in a few days.  The patient, calmly and matter-of-factly, said, “There’s no need dear; I’m going to die today”. 

And, for no clear reason and without apparent cause, she did just that only a few hours later. 

 This case made me sad, but also hopeful.  It’s reassuring to see that some people really do live without significant illness or loss of mental capacity for well into their 90’s.  It’s nice that some families understand that death is ultimately unavoidable  and that sometimes letting their loved-ones die peacefully, without pounding on their chests or putting tubes in every orifice, is more humane and loving than the alternative.  This patient lived and died with dignity, which is the most that any of us can really ask.

Posted in The Medical Trenches | 7 Comments »

Merry Christmas to all!

Posted by Amy on December 24, 2007

I can’t compete, so I’m not even going to try.  Check out Ten/Ten’s latest blog for a Christmas poem to remember. 

With that, I wish you all a Merry Christmas.  I will be working on Christmas morning, so feel free to stop in and say Hi.  If today was any indication, I’m sure I’ll be up to my elbows in Fast Track patients, viral URI’s, belly pains and lonely old people just looking for a little love. 


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Insurance cards carry germs too

Posted by Amy on December 23, 2007

We got a new registration lady this week who I find quite amusing.  At my hospital, we do bedside registration.  So, the patient gets put in a room and then during their first few minutes/hours in the ED I see them and the registration folk see them and get all of their insurance information, address, name, etc.  Anyway, a few days ago the new registration lady (we’ll call her Betty) approached me before going in to one of my soon-to-be-patient’s rooms.  Here’s the conversation that took place…

     Betty: Is it okay to go in there?

     Me:  Uh, sure, I don’t see why not.

     Betty:  Well, do I need to wear anything special?

     Me:  What do you mean?

     Betty:  Does he have something contagious?

     Me:  Probably.  I haven’t actually seen him yet.  I don’t know his medical history – he just got put in a room. 

     Betty:  So, you just go in rooms and talk to patients without knowing if they are contagious?  What if you get sick?

     Me:  Well, that’s part of the job.  This is the ER.  There’s no way to know what anybody has until you talk to them and check them out.    There’s really no other way to do it.

     Betty:  Wow.  You’re really brave. 

I’m not sure how long old Betty is going to last if she plans on putting on a Haz-Mat suit before going into each room to take people’s insurance cards!

Posted in The Medical Trenches | 1 Comment »

Falcon Lady

Posted by Amy on December 20, 2007

Favorite patient of the holiday season:  “Falcon Lady”. Found flying around the ED waiting room.  This 50+ year old lady had a straw hat on with a colorful array of feathers sticking up.  On her shoulders, she carried a full set of kite-like falcon wings that spanned a good 8 feet across.  Her only verbalization was bird noises.  Sorry, Falcon noises.  The reason for the ED visit was unclear, but may have had something to do with a psychotic break.  But that’s just speculation. 

Posted in The Medical Trenches | 1 Comment »

The case of the very happy surgeon

Posted by Amy on December 17, 2007

The other night I saw something that is pretty darn rare in the middle of the night on a weekend.  What was it you ask?  A very happy surgeon.

At 8pm I had called the surgeon on call and asked him to please come in and drain a huge perineal (groin) abscess in a diabetic man.  We see tons of abscesses (aka: “spider bites”) and drain them on an hourly basis, but this one was big and nasty and deep and in the wrong place so I felt that operative drainage would be better.  The surgeon (who was, conveniently, driving home from elsewhere and was just down the street) arrived to do the I&D within 10 minutes of me calling him.  I hadn’t met this guy before, but he was so friendly I had to shake myself to belive that it wasn’t some bizarre ER dream. 

He finished the abscess case and went home.  Later, at about 1:00am, he was called back by one of my collegues for an appendicitis.  When he arrived, I said hello to him again and commented that I was sorry to have to see him back in the ER.  He looked at me, smiling, and said, “No problem – it’s my job”. 

Wow.  I was speechless.  That’s something you don’t see everyday!

Posted in The Medical Trenches | 5 Comments »

“There was an old lady who swallowed a fly…

Posted by Amy on December 11, 2007

...I don’t know why she swallowed the fly.  Perhaps she’ll die.  I know an old lady who swallowed a spider…she swallowed the spider to catch the fly.  I don’t know why she swallowed the fly.  Perhaps she’ll die.  I know an old lady who swallowed a… (this song  was a childhood favorite and continues until she swallows a horse).  I’ll spare you the entire song but the morale of the story is clear.  Don’t swallow a horse to catch a fly.  Or something like that.

A man came to the ED complaining of “stuff stuck in my ear”.  That “stuff” was bubblegum.  When asked why a perfectly normal appearing man had gum in his ear, his answer was “to get out the wax”.  Clearly, he’s a real forward-thinking fellow.  He chewed the gum a few times, keeping it nice and oooy-gooy sticky, and then placed the gum in his ear canal.  Then (you guessed it!) he couldn’t get the gum out.  So, he chased the gum with a good bit of Q-tip probing (pushing both the gum and wax up against the sensitive ear drum).  Finally, he aborted his misguided mission and came to the ED for help.

Unfortunately, getting newly-chewed gum out of the ear is no easy feat.  After much screaming (on his part) and probing (on ours) he still had gum stuck in the ear.  ENT was called (“what a dumbass”) and agreed to take the man to the OR to get out the goopy substance. 

So, that’s the lesson, boys and girls.  If you swallow a fly, ignore it.  It’ll work it’s way out eventually. 

Posted in The Medical Trenches | 1 Comment »

When they read the textbook

Posted by Amy on December 2, 2007

62 year old man comes in brought by ambulance after the family became concerned when he was “acting goofy” earlier in the day.  Normally, he’s a fully functional, independent man.  Today, he appears “zoned out”, drowsy, restless and confused.  He doesn’t recognize his son. 

Two days ago the patient started a Z-pack for a sinus infection.  Today, he’s had a fever and has been holding his head like it hurts. 

When I walk in the room, I get the above history from his children.  At which point I escort everyone (nurses, techs, family) out into the hallway and have them all don droplet prevention masks before returning to the room.  We get a stat CT head, meanwhile starting antibiotics and steroids.  Of course, CT is normal.  I’ve already talked to the family about the most likely diagnosis and they’ve consented to a lumbar puncture, which is done as soon as the patient returns from CT.   

The LP pressure is high – the fluid goes to the top of the little measuring device thing-a-ma-jig and would have gone over the edge if I had let it.  The liquid, which should be water-like in consistency, is cloudy.  When I get the results back later, my suspicion is confirmed.  The CSF has 2000 WBC (87% Neutrophils), 380 Protein and zero Glucose (to which my friend and fellow physician remarked “how are all of those bacteria living when they’ve eaten up all their food supply?”).

This man had a bad case of bacterial meningitis.  A textbook case, probably seeded from his sinus infection.  I had never actually diagnosed bacterial meningitis (although I sure have spent a lot of time looking for it).  Luckily, this case wasn’t subtle.  I’d heard before that these people look sick.  Yes, indeed they do.

Posted in The Medical Trenches | 8 Comments »

I went to bed skinny and woke up fat

Posted by Amy on November 27, 2007

I mentioned it once before, sort of in passing, but I’m currently the host of two identical girl twins, who are brewing in my belly as we speak and have been doing so for over 17 weeks.  I haven’t written much about the goings-on with me and the small growing munchkins yet because, frankly, there hasn’t been a whole lot going on. 

For three months I was sick on a daily basis and often times didn’t have enough energy even to roll over on the couch, much less force myself to go to work in the ER.  One day, while talking to a pleasant 8-year old and her father the world around me just went black and I got sweaty and reached for the wall, narrowly averting passing out in front of the entire ED.  Other days, I was just so darn tired I could barely walk from one room to the next.  And, heaven forbid, if I made the long journey to a new patient’s room and found that (as usual) the patient or patient’s family had stolen my “Staff Only” stool, I would simply sit down next to the patient on the bed because I honestly couldn’t stand a second longer (see Ten/Ten’s entries about getting in bed with patients for more on this fascinating topic).  Oh, and of course there was nausea.  One day I walked in to a critical patient’s room, took one look at the 75-year old man with a pressure of 70/35 and I made sure he could mumble his name before jetting out of the room to the nearest bathroom to purge myself of my well-intentioned saltines and ginger ale from breakfast. 

That’s what I’d been up to.  Until now. Luckily, I’ve pretty much gotten past all of the fatigue and nausea and am able to eat normal size meals without thinking twice.  I hadn’t been gaining weight (apparently saltines don’t pack on the pounds) and my daily attempts to make my belly look bigger in the bathroom mirror had been unproductive.  Until today.  I went to bed skinny and I woke up fat.  Just like that.  A big fat belly that pokes out of my lounge suit (purchased because I’ve never had a lounge suite and doesn’t it sound fun to wear one around all day?).    

I’m still working and all is well.  When I get bored, I sneak in to one of the patient rooms with the ultrasound machine and watch the twins punching each other in the head.  Last night I felt Twin B kick me and confirmed with the ultrasound that she was, indeed, using my right side as a soccer ball for no apparent reason (didn’t she know it was 3:oo am?).

So, that’s what’s going on with me.  Walking slower.  Getting fatter.  Starting to wobble a bit.  And couldn’t be happier.

Posted in Friends & Family, The Medical Trenches | 10 Comments »

A sailor among us

Posted by Amy on November 21, 2007

A few days ago, there was a very upstanding (i.e.: drunk/high/belligerent) individual in room 6.  He was restrained and cursing loudly for all the ED to hear.  In fact, at one point I decided to amuse myself by counting the number of F-bombs he dropped in a 30-second period of time (21, to be exact). 

A little while later, I was talking to this particular patient’s ER doctor and had mentioned what a charming fellow her patient was.  She said, “Yes, I feel quite sorry for the man.  He clearly should have paid more attention in school – his vocabulary is rather lacking!”  

Well stated, I thought. 

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