I cut my teeth in the ED.
My daydream job when I was a CHILD at age 7 was ER doc; I spent years of my life taking notes every Thursday during “ER” and the rest of the week looking things up.
Once I grew up, I spent ten years in various roles in the ED before I ever even went to nursing school.
It was an ED doc* who nudged me along the path and told me that if I couldn’t bring myself to go to medical school (because I was raising my sister), then I should go to nursing school, and hey while I was at it, maybe I should consider becoming an NP.
After graduating with my RN, I took a job as a float nurse and relished the shifts I spent in ED.
I very frequently think about going back to the ED now that I’m a nurse practitioner.
ALL THAT TO SAY, I love and respect the ED and I know full well what it’s like to work in that environment, from so many different angles.
So when I sent a patient to the ED yesterday because his kidney function fell off a cliff (from a GFR of 65 to 9, from a creatinine of 0.83 to 5.39) and he developed bilateral hydronephrosis without being in urinary retention, and when I called the ED to tell them why I was sending him in, and asked them to do a CT and call me when it inevitably showed a mass in his abdomen so that we could come poke holes through his back and into his kidneys so he didn’t die, and then he spent 7 hours in a waiting room, I was disappointed to say the least.
He left. He couldn’t sit in those chairs anymore and he went home.
I called him and begged him to go back this morning. Miraculously, he did.
When I went to round today, I deliberately entered through the ED.
“Hey, where’s Mr. [LastName]? I sent him up here, I figure I ought to say hello before I start my rounds. … What do you mean he’s in the waiting room? His GFR is 9.”
The ED doc goes, extremely confidently, “no, that’s falsely low. GFR is weight-based. We saw him yesterday and the triage nurse put his weight in as kilograms not pounds, by mistake, and it hasn’t been fixed yet. Unless he gained 120 pounds overnight, it’s just a calculation error.”
ED docs are brilliant, they have to know so much. I have so much respect for them.
It always feels so personal when they’re assholes.
One, don’t talk to me like I’m fucking stupid. I know how an eGFR is calculated. I can do it by hand.
Two, even if it was a calculation error, with them overstating his weight, his GFR would’ve been falsely elevated to 9. Not falsely decreased.
Three… “That lab result was from before I sent him up here. It was why I sent him up here. The weight error wasn’t made until after his eGFR was calculated to be 9. Is creatinine weight-based, too? Because it’s almost 6. He needs neph tubes. My surgeon had IR on standby when I sent him up here yesterday.”
I called. I gave report. It’s in his chart that I initiated the transfer.
And they fucked around for so long on the SECOND DAY that he had to be transported 40 minutes away (because our hospital only has interventional radiology until 5pm on fridays) . Which means his extremely elderly wife has to drive 40+ minutes away to the trauma center and navigate a city and pay to park to be with him while we try to save his life. Which is substantially harder now that we’re 36 more hours behind the goddamn 8-ball.
My problem with the ED is this: from their foxhole, there are two types of patients that can walk into any given ED. The type that doesn’t belong in any ED (“why are you here?”), and the type that doesn’t belong in this ED (“why are you here?”)
If a patient can’t be taken seriously when another provider has already pre-vetted their emergency, who the fuck CAN be taken seriously in the ED?
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