Futility

While walking home last night after a shift in Purgatory, aka The Pit, aka Unit 2, aka "Shitters & Bleeders" aka Hell - take your pick - I couldn't help but think that I had just squandered 8hrs of my life dealing with people for whom medical care appears to simply enable them to continue living their dysfunctional screwed-up lives.

Our department is divided into three general areas: Unit 1 in which all the "major" stuff goes - anything requiring a cardiac monitor, resuscitation and the like goes there, Unit 2 - which I have already described above, and the ironically-named "Fast Track". Unit 1 is usually a mixture of the routine and boring with the weird and wonderful "sickies". It's where all the "action" happens if there is to be any action. Sometimes it can be mind-numbing - 20 heart attacks in a row, anyone? - and other times I still can find my heartrate quicken a little when someone comes in and drops dead.

Then there is Unit 2. Unit 2 is where all the "not-so-sick" and the "kinda sick" and - to some degree - the "not sick at all" or the "sick in the head" patients end up. Some of my colleagues call it Purgatory, others The Pit. I call it Shitters and Bleeders because the vast majority of patients in Unit 2 are either having abdomen-related issues (shitters) or pregnancy-related problems (bleeders). Unit 2 is where you can be lulled into making a mistake, precisely because of how mind-numbing it is to see nothing except "abdo pain" and "pregnant and bleeding" over and over and over again. It's where you can miss a diagnosis and have something potentially bad happen because of that. It's where I spent last night.

Fast Track is anything but fast. It really should be called the Slow Track because this is where we see the people who for some strange reason decide to come to the ER instead of seeing their family physician about their runny nose/cough/cold/sore throat/finger pain/ankle sprain etc etc etc. This is also where most minor lacerations get seen and sewn up. Fast Track is fine for the physician (this is where "moving meat" takes place if/when a physician can be freed up enough to get around to it). Usually, there is a dedicated physician taking care of Fast Track 6hrs a day but if you have made the mistake of visiting the ER for your sore thumb and Fast Track is closed, your thumb will probably no longer be sore by the time we get around to your chart.

Anyway, after spending 8hrs in Unit 2, I have concluded that the ER has some patients who have a life cycle all of their own. An example.

1. Patient abuses over the counter medications.
2. Patient then goes to get bloodwork done.
3. Patient's blood is fucked up by medications abused.
4. Blood machine spits out result.
5. Result reads: **CRITICAL RESULT ACTION REQUIRED**
6. Patient is immediately contacted and directed to ER
7. Patient is seen in ER
8. Patient is given whatever it takes to correct fucked-up bloodwork.
9. Fixing fucked-up bloodwork takes hours and hours.
10. ER becomes more and more overcrowded thanks to patients like Patient.
11. Patient's bloodwork sent again to lab.
12. Patient's bloodwork now fine.
13. Patient sent home.
14. Patient abuses over the counter medications.

See how it works? In the end, the biggest enabler for the patient is none other than yours truly. We fix him so he can go out and do it all over again. And again. And again. And it's patients like this that make me angry because I feel as if I am using this gift of mine to propagate this stupidity. It's different from patients whom we see who have chronic schizophrenia or other such illnesses which make them unable to exercise reasoning choices that promote their own wellbeing. It's different because these patients - the group to which my Patient belongs - know exactly what they're doing and they get away with it.

I'm still young and idealistic, which is why patients like this make me angry. I know that eventually I won't care any longer, at least not enough in any case to be angry. It's pointless, as an older and more senior colleague tells me, to question any longer the things we see. I understand what she means - and yet I don't understand because I really do want to know what on earth we accomplish by saving these lives, fixing these people who don't want to be fixed except for the sole purpose of going out and breaking themselves again. It seems pointless and stupid.

But what do I know, right? I'm just a lowly ER doc. So I'll keep fixing them and sending them on to get broken again. Maybe it's people like these that keep us in business. I suppose it's good for my wallet in the long run?