Monday, Monday. Can’t Trust That Day.

What is it about Mondays in the E.D.?  I’ve talked to several colleagues of mine, and we all agree:  Mondays bite.  It’s the one day of the week when you can count on the mad rush of humanity coming in through your open doors.  Our residency program does sign out at 0700.  There’s usually  a few EtOH metabolizers or waiting for social work placement patients taking up a few beds.  The dental and STD patients started to arrive about 0630, so they’re good and ready to be seen by the fresh crew.   By 0800, ambulances start making their geriatric runs dropping off the weaknesses, AMS, choking episodes and difficulty ambulatings.  Around 0900 the next wave of gurneys arrive with the abdominal pains and short of breaths.

By 1000, the walking wounded begin to arrive:  back pain, leg pain, headache, and chest pains.  This is also the time when the “expect calls” start.   “Hi, I’m sending in this Marfan’s patient who’s had their aortic valve replaced, multiple abdominal surgeries, who by the way also has diabetes, HTN, and a liver transplant who came to the office this morning complaining of a strange pressure in their mid-abdomen, maybe in their chest. Would you please check them out?  It’s a half day in the office for me today, but I am sure the hospitalist service will be happy to admit them.”

1100 is when the real fun starts, the early HD patients start coming in with bleeding from their AV fistula sites, syncopal or hypotensive episodes that did not allow them to complete HD.  Oh yeah, they still have a potassium of 7.  Or, they missed their morning HD session and now need urgent dialysis because they visited their girlfriend who lives out of town and didn’t think to take any of  their medication with them.  This is also about the time that that coronary who thought they’d just had bad sushi for lunch realizes they’re having an MI and walks in the door.

Are your beds full yet?  It’s 1400 and you’re finally getting the last of your LOLs in NAD dispo’d.  You haven’t eaten.  You’re grumpy, and, all the patients who are supposed to be NPO for thier 10/10-I-need-that-Dil-ah-something abdominal pains have been complaining about not being able to eat or drink anything despite the fact they just swallowed down about a liter in contrast and told you earlier they haven’t been able to eat in three days.  Around this time, PMD’s offices begin closing or referring their patients to you.  You start getting the “I called my PMD about my nausea and vomiting for the last 3 weeks and he told me to come to the E.D.” patients.

At 1700, you’re swimming against the tide.  Fast Track is closed.  All the leftover lacs, ankle sprains, med refills and wound checks start filling up the waiting room.  The hospital housekeepers drop from 3 on the inpatient floors to about 1 on the floor, so your admits are sitting waiting for a clean bed.  Your dispo’s are all pending return calls from the PMD’s or consultants who are driving home and caught in traffic and unavailable to answer thier pages.  Ambulance gurneys are lining the hallways waiting to unload their shortness of breaths and abdominal pains that waited all day to call their PMD’s and then called late in the afternoon only to find the office was closed. This same group will stop deep breathing into their NRBMs and moaning and start yelling and raising a fuss when the gurney with the non-compliant, diaphoretic, hypertensive CHF exacerbation comes tearing into the ED and bypasses everyone to go straight into the Code Room.

That last hour you’re just watching the clock.  Should I see that GIB or leave it?  The lac can wait.  Maybe I better page the MICU again.  Can I get that 84 year old with no family admitted since I saw them at 1755 and Patient Placement leaves at 1800?  Where is my pen?

Sign out is at 1900.  “Sorry the board is such a mess.  But, you know how bad Mondays can be.”

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