I Can Do That

I work in a small, rural Emergency Department located near the Redwood Forests of Northern California so we get a lot of tourist travel coming through from Portland and San Francisco. Now, I understand that we don’t have the resources (read none) that some of the bigger tertiary centers have in the Big City, but that doesn’t mean that we can’t handle what comes through our small E.D. And, especially now during the summertime we get a lot of Out-of-Towners who wonder what I can handle.

“No, Ma’am, we don’t have a pediatric plastic surgeon. Yes, I understand that your 2 year old’s pediatrician told you that if she ever cut her face you should consult a plastic surgeon, but I think about 3 stitches on that lac above that eyebrow will make the skin come together nicely. Yes, they will have a small scar. Well, you can drive 5 hours south to the Bay Area and see if a plastic surgeon is on-call at the Children’s Hospital, but that’ll make about 7 hours since the laceration happened, and you’ll wait about 2 – 3 hours there while the surgery intern on-call comes down to sew her face. Or I could do it now, and you’ll be back to your hotel room within about an hour.”

“So you have a fracture of your arm. No, we don’t have an orthopedist in-house. Well, I have one on-call, but you have a simple fracture that isn’t displaced, and we splint those here in the E.D. Yes, I understand your Portland orthopedist would be at your bedside giving you a Perrier and a Valium while their P.A. splinted your arm, but I can offer you a Percocet which will kick in about half an hour after your motorhome reaches the 101. Um, would you like that now or to go?”

“Your husband has a collapsed lung, bleeding in his pelvis, and a blood clot in his brain. I’ve put in a breathing tube, a chest tube, and a central line plus we’ve binded his pelvis. We’re flying him to a trauma center so a neurosurgeon can take care of his brain. Drill into his brain like they did on “Grey’s Anatomy?” No, I can’t do that.”

  1. #1 by Haler - August 18th, 2011 at 07:17

    This site, in particular the broken arm story, console me. Having handled Mom’s med+MH+Fed/State insurances care with my sibs since 1972 when dad left, I’ve seen too much, as have you. But your stories give hope, health, and comfort to families untrained in medical ethics. For example, 4 years ago, then 80 year old mom fell in her assisted-living apt., the Admr phone me (45 minutes away) to fetch her to her to her primary MD’s hospital (5 minutes from my home), on doctor’s orders. Leaving work, verifying I have med sheets, legal forms, arranging my childcare on the way, Hospital ER intake apologizes for full parking and unposted roadwork blocking ER’s entrance. They refuse to see mom till they have her lab and xrays in hand, we can go to those floors and offices ourselves. Lab didn’t have us in their system yet, staff was at morning break. 8:45am-10:30am to intake including computer downtime. “Ma’am, full panels are required for first hospital intake since we don’t have geri-neuro anymore despite doctor’s order.” “But … ” “We’ll wait for a manager’s approval when he returns.” At noon, we get sent to Xray, provide info. They get us out in an hour. Two left forearm xrays in my hands (tjey wanted to interbranch them to ER next day), I elevator with mom, her walker, my always-ready admit overnite bag the 4 floors and numerous hallways – to the hospital cafeteria for late lunch and her meds and restroom stop. Almost an hour later, we get to ER where I hand them her x-rays. “Her doctor isn’t here today so we can’t act without his review of these pictures.” “It’s 3pm and we started here at 8:30am at his order.” “Hospital rules, and besides, the order says your mother has a ‘sore arm’. Why is she so pale?” “Please call the doctor at his personal number, sir. Her facility had me bring her here at doctor’s orders.” Flurry of staff shuffling papers and whispering. Then, “Ma’am, our on-duty will review the images, and confirm by phone with her MD, just hang on a bit.” It’s 4:30pm. “Her doctor is unavailable, and we confirm her arm is broken and the one bone should be set.” “Okay, I’ve given current insurance to 4 hospital staff, here, admitting, lab, and x-ray. She’s good to go.” “We’re only authorized by her MD to ace bandage her arm. And here’s your instructions with the 3 followup staff doctors with whom you can set an appt next week for setting that nasty break.” “It’s 6pm and we got here at 8:45am and mom’s been in pain. Can anyone here look at her med list and Rx something?” As he checks her ace bandage, the not-a-doctor and not-an-ER-staffperson states, “Ma’am not without her MD’s approval and insurance pre-auth. Why not grab some dinner at our cafeteria” and talk about it.” I hold up the entire sheaf of papers I brought, with the past 8 hours’ accumulation. Mom says softly to me “my dear, I sink I vood so like to go on to mine little room again, I’m am not so daisy-fresh mit energy anymore. Vee can sink over ziss all later. If Hitler’s war didn’t kill me, this von’t.” The intern smiles, a bit too confidently smug for my taste. Her house kept an excellent dinner tray and smiled proficiently and genuinely. I had the desk give prop mgmt a call to advise my County Ombudsman and AMA reports were initiated over this. 6 weeks later, a “specialist” rebroke mom’s improperly set arm. It’s an inch longer, and pain free, but with 3 new angles 2″ and 5″ away from her wrist. Well, she crochets and writes right-handed.

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