Twenty in the Waiting Room



I think the emergency departments are getting back to normal. At least, the ones I work in seem to be.

For months now while I on duty I waited around aimlessly as occasional patients would trickle in here and there. Apparently, most people were choosing to have their heart attacks and strokes at home rather than come to the hospital and risk contracting the coronaplague. Although at its nadir our volume was literally cut in half, the patients that did show up were generally much further down the illness progression timeline, necessitating much more aggressive actions to stabilize and reverse the disease cascade. Sepsis comes to mind- that state in which an infection spreads like wildfire through the bloodstream so aggressively  that the body's defenses become overwhelmed and circulation collapses from an immune system gone haywire. After one hour of the "sepsis state," survival drops precipitously, often irreversibly. Avoiding the ER for these patients is tantamount to a death sentence.

The walking ill are beginning to once again show up. Those who were deep into their social distancing alcoholic benders are returning in advanced states of withdrawal. The mental health patients off their meds are coming back (at least the ones left who haven't committed suicide while under government-ordered isolation). Women are starting to brave the pandemic to be treated for domestic violence injuries sustained while under lockdown. Pelvic infections from STDs are spiking. Type 2 diabetics, victim to their dietary indiscretions while bored at home, are appearing for intravenous insulin, or to have their ischemic limbs amputated. People who had their scheduled cancer staging biopsies cancelled are now showing up to see us in a more advanced state of their condition. 

Yes, they are all coming back. For the first time since late winter yesterday I walked into a packed department with 20 patients in the waiting room. The ER in March and April had, generally speaking, been a ghost town. People stayed away as they grew steadily more ill, fell deeper into their addictions and destructive behaviors, or let their cancers grow unchecked. At least yesterday we were almost back to pre-COVID volumes. And everyone I treated seemed, sadly, profoundly sicker. I admitted 80% of the patients I saw yesterday to the hospital. That number is usually around 30%. 

But the great news is that they avoided the ‘rona! 

The Legacy of the Plague...



Comments

Post a Comment

Popular posts from this blog

Frank Gallagher?

Image
I r ecently rediscovered TV after months of not even turning my set on. The show that has currently hooked my attention, and that I recently began to binge watch, has been Shameless with William H. Macy and Joan Cusack, about a big dysfunctional family living and struggling in Chicago’s rough South Side. It is a hybrid of drama and dark comedy. Both the character of Frank Gallagher as well as the narrative holds true to the show’s name- each episode is saturated with drugs, violence, and gratuitous fucking (too much, in my opionion, even for a Showtime original). Macy does a great job portraying an alcoholic deadbeat, good-for-nothing, scheming drunk who is completely inept as a father. What the viewer can also glean is that even through his stumbling, bumbling ways, Frank is smart - he seems to eloquently lie and scheme his way into money, sex, and his family’s attention, waxing poetic to get what he wants most of the time. His character both resonates and alarms me, and as I watch hi
Read more

Nothing Comes Before It

Image
As we have now put a dent in 2021, and my bloggerlust is slowly awakening- partially from topic inspiration, partly on the encouragement of my dear one- I recognize that these twelve months have the potential to surpass my wildest permutation of the future. Six weeks ago I rang in the new year with an entirely new (and completely unexpected)  magical pouch brimming with hope and exciting prospects, and as we turn a snowy corner towards spring, many of those prospects are coming to fruition. Work is stable, my physical and mental health continue their upward trajectory, and I am hopelessly and willingly steeped in an amazing new relationship, the bliss of which is gloriously transcendent. My existence appears to be humming along on all cylinders. I finally feel like I've got this “life thing” down. Danger, JD! You are so busy celebrating yourself, gleefully patting yourself on the back that you are subtly distancing yourself from the original source of your stability and growth in y
Read more

Intubating Alcoholics

Image
In the past week I have put three alcoholics on life support. The first one was 39 years old. He arrived to the emergency department by EMS unconscious with almost no blood pressure. I placed my ultrasound probe on his heart and saw it was beating alright,  just very little blood was entering his ventricles. This is because he was bleeding to death. When I intubated him I saw pooled blood in the back of his throat. His liver was so far gone, so cirrhotic, that blood could not easily pass through it, and the backup and created high vein pressures on sensitive areas like his esophagus and stomach, whose linings themselves were eroded from the caustic effects of constant boozing. He was literally hemorrhaging internally, and it took many units of blood to even get a pressure back. He made it to the ICU, and later that night, died. We later learned from family that he had moved back to town "to get sober." Case two was  a 53 year old chronic alcoholic who came to me con
Read more