Tuesday, May 29, 2007

I was right. Unfortunately.
All hell broke loose in the ER; this week is going to be a busy one. We coded purple today: no new admittances to emergency because all beds were full and all staff, including on-call, were working. It was mayhem. There were codes called every other hour, either cardiac arrest or respiratory failure. The rotation through the rescue bays were brisk.
Sadly, it was the chaplain who was the most busy, praying over and comforting families who were shocked and in grief from sudden and unforseen tragedy. In ER, this is the reality. People do die and we need to be ready to move right on to the next patient.
I felt stuck at one point during this day. Stuck on a patient who seemed to be perfectly fine, who'd walked into the ER with his coat over one arm. A little apprehensive-looking but walking erect and hadn't come in on a stretcher. So given the present circumstances in Emergency, you can understand the slight frustration I had in encountering this patient. Frustration especially at attending physician who had written me the consult. His chief complaint was completely ridiculous: he complained of choking on milk in the middle of the night. No other complains. No pain, no trouble eating during the day, nothing. I almost left him right there in the examining room. I ran through my history-taking interview, did my routine checks, tried all food consistencies (even milk!) on him: no coughing, no choking, no voice change. By then I felt like I was wasting my time doing absolutely nothing with the perfectly healthy-looking man. Just for kicks I decided to do a test in radiology, a modified barium swallow, before I wrote up the paperwork to discharge him. I ran to the attending MD, did some mad venting, then got the requisition and ran the test.
And I found a hernia. A paraesophageal hernia of the stomach that his stomach acid was refluxing into. Apply some pressure, get a rupture and the gastic acid would have filled the abdominal cavity, leading to damage of major organs and even death.
He's going for surgery tomorrow.

Moral of the story: Patience, thorough clinical care, and go to ER when you're choking on milk in the middle of the night.