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The Day This Doctor’s Best Friend Died

By Birdstrike MD “Would you know my name, If I saw you in Heaven?” -Eric Clapton, Tears In Heaven Pete was my best friend.  I had known him for over 10 years.  Pete was more than just a friend.  Pete had become part of my family.  All of Pete’s relatives had died.  He was born in a different state, and when he came into our lives, Pete had no one but us.  You could say my family adopted him. Pete was quiet.  I swear it seemed like he never talked.  I’m quiet, too.  I think that’s why we got along so seamlessly, and without drama or complication.  We had quite the connection.  Words were overrated to me and Pete.  Pete and I liked to do the same things.  We both loved to run.  We went on countless runs together.  I preferred to run alone, and Pete was the only real training partner I had ever wanted to run with.  Pete had even helped me train for a marathon.  Pete just liked to run with me.  That was enough.  Pete didn’t care who was faster.  I liked to think I could outrun him.  I was kidding myself.  He never went ahead, though.  The truth was, if he wanted to beat me, he could have run twice as fast, twice as long, but he always held back out of respect, I think.  Pete was significantly younger than me.  My only hope of beating Pete in a race was to wait for a 90 degree day.  The heat was his Achilles heel.  Pete’s speed disappeared in the heat.  Nevertheless, we bonded over countless miles, during many great runs together. Pete was a super loyal friend; in all honesty, much more so than I.  I don’t know that I ever did anything to deserve how loyal and dedicated a friend Pete was.  That’s just how Pete was.  You almost got the sense he’d lay down his life for anyone of us.  Most of what I gave Pete was just someone to hang out with.  Other than running together, we spent lots of time outside.  We shared a great love for grilling steaks, and we’re both suckers for any sport involving a ball.  No one loved a great juicy rib eye as much as him.  Pete also had a strange liking for popcorn. In all the years I knew Pete, I never knew him to have any career in the traditional sense, like a doctor has.  That’s unless one considers being a boxer that never received a real paycheck a “career.”  He also worked as a volunteer security guard.  Some would say that made Pete a free-loader.  Sure, he was a sucker for a free steak and a rent-free roof over his head, but I never held it against him.  He more than made up for it in the intangibles. My wife and kids had bonded with Pete as much as I had, since we were his adopted family.  My kids had grown up with him.  Many times in the summer, we’d hang out at the pool.  He’d play ball with my kids.  Pete loved kids.  Pete was in as many family photos as my own kids.  Brown hair, brown eyes, there’s Pete again! One day, Pete was tagging along as my wife pushed my youngest in a stroller.  A viscious dog had aggressively lunged at the stroller.  Pete threw himself between the baby and the dog, without hesitation.  Pete could have been eaten alive.  The viscous dog backed down.  Pete was forever a hero to our family after that day.  From that moment on, ...

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Blown Away

By Birdstrike MD I was a work today and I was given this message, “ —–‘s husband called and wants you to call back right away!  He sounded very upset.  His wife died.” Uh-oh, I thought to myself, this is never good.  It was a patient I remembered well, that I had seen repeatedly for a chronic problem, and who always came with her husband.  We seemed to get along well.  I didn’t recall any conflict, unpleasant interactions or any immediate life threat that might have been ominous. There were no complaints to administration.  I looked in the computer, and I hadn’t seen this patient in over 3 months.  I debated whether or not to call back, not knowing what beehive I would be getting into.  Did I do something wrong?  Am I being sued?  Surely I am going to be blamed for this in some way?  Maybe returning this call would not be such a good idea. I decided to call back.  After all, I knew the curiosity of not knowing what happened would torture me more than simply calling and facing whatever was coming my way.  I had a few extra minutes, so I dialed the phone and called. “Hello,” answered the familiar voice of Mrs. —-‘s husband. “Hi, this is Dr. Bird.  I got a message that you had called.  I’m sorry about the terrible news,” I said. “Yes, she died 2 weeks ago,” he said, his voice crackling and wavering.  “I thought you would want to know.” “Yes, absolutely, thank you for calling.  Again, I’m very sorry about your loss,” I said.  “What happened?”  I was afraid to hear the answer. He went on to explain that 3 months after I had last seen his wife, her condition began to deteriorate (from something unrelated to what I saw her for).  He paused and choked up repeatedly in telling the story, the tears and emotions still raw.  She ended up in the ICU and on life support.  Her condition worsened, beyond any hope.  To respect her wishes, he decided to withdraw support, as she requested.  As a result, she died.  This concluded many long and painful years of an excruciatingly painful illness.  Nevertheless, he was crushed. “She was a very strong woman and she went through a lot,” I said.  “I’m sure you miss her very, very much.” “Yes, I do,” he said.  I could hear him now choking back full tears.  “Most of all, I wanted to call and tell you thanks, for all you did trying to help her.  I want you to know she thought the world of you.” Wow.  That was a shocker.  After all the years of hurried patient interactions, the long nights, the grinding day shifts, and the routine ins and outs, unexpectedly, this one stopped me in my tracks.  I have to admit, he got me.  I was totally caught off guard, by the appreciation in the face of such a hurtful tragic loss.  I had come to expect utter negativity and un-appreciativeness at all turns. “Wow, sir.  Thank you.  Thank you for calling.  I really appreciate you letting me know,” I said, in disbelief, and humbled.  After years of being a doctor in various setting, with 30,0000 or more patient interactions and counting, I can honestly count the number of times I have received this type of thanks on one hand.  At least for the moment, this one “thank you” seemed to have made up for many thanks that likely were felt, yet not necessarily sent or expressed, and likely drowned by a much noisier negativity more demanding of ...

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What I Can Tell You Is, “Thanks”

By Birdstrike MD I can’t tell you that the “patient satisfaction obsession” is suddenly going to focus on patient health over profits and start being applied fairly to doctors and nurses. I can’t tell you that someday politicians, administrators and insurance companies will wake up and see things the way you and I do. I can’t tell you that someday, all the demands for inappropriate medications, tests and treatments will end. I can’t tell you that all of a sudden the government will stop making cumbersome and nonsensical rules and regulations, stop crushing private practice and start increasing instead of decreasing doctor pay. I can’t tell you that all of a sudden you are going to stop taking hits in the line of duty for doing the right thing for your patients. But what I can and will tell you is that I appreciate every time you or any other doctor, nurse, physician’s assistant, paramedic or tech laces it up for a shift to take care of the sick and injured. I can tell you, “thanks” for everyone too sick, too short of breath, dizzy, psychotic, weak, unconscious or too intoxicated to say it or realize it themselves. I can tell you that I appreciate all the blood, sweat, tears and REM sleep you leave on the floor during your days and nights on the front lines treating the sick, bleeding, broken, bruised, and destitute. For what it’s worth, you are a hero to many, whether they say it, know it, or not. I’ve been there, done it and still face the same battles.  What you do is not easy. It’s incredibly difficult. Don’t ever let anyone tell you otherwise, including yourself. You make a damn big difference to this world. For anyone who steps up to the plate in an Emergency Department, hospital, OR, or doctor’s office to be there when no one else can or will, to wait for me, my family members, your own friends, enemies or complete strangers to pass out, get run over, to arrest or stop breathing, keep your chin up. For what it’s worth, you’re a hero to me. Happy Holidays, Birdstrike MD . . .

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“You’re Next”

By Birdstrike MD I saw a story in the news about something that happened to an ER doctor.  It reminded me of something that had happened to me before, so I started writing about it.  Then my imagination got a little bit carried away.  So, let’s just say parts of this story are absolutely true, and other parts are, well…just read along.  I walk in for my ER shift.  There’s a letter in my department mailbox.  It’s a hand written letter from a patient.  I open it, “Hey doc!  I just wanted to thank you for taking care of me last week.  It was one of the low points of my life and I really had hit rock bottom.  You’re the first one to talk to me like a human being.  You convinced me to get help.  They finally let me out.  Thanks, again.  You saved my life.  You’re a great doctor.  We should hang out sometime.” Sincerely, Jerry —– Cell: XXX-XXX-XXXX” I remember the patient.  I admitted him for severe alcohol intoxication, depression and suicidal thoughts about 2 weeks ago.  It’s not that often that you get to start out a shift with a “thank you” letter, albeit with a bizarre request at the end to “hang out sometime.”   In this ER game, you take every pat on the back you can get, because they don’t come every day. I walk to the pit to see my first patient.  First up is, “Broken wrist.”  I walk into the room and it’s him, Jerry, the letter writer.  “Hi, Jerry, what can I do for you today?” “This,” he holds up his mangled right hand and wrist.  “I got pissed off and punched a wall.” “Wow, you sure did a number on yourself.  What happened?” I ask. “Did you get my letter?” he asks. “Yes.  Why do you ask?” I wonder aloud. He stares at me silently, and uncomfortably long.  “Oh, I don’t know,” he trails off, staring through me.  “Just fix me up, and we’re good.” I walk out of the room.  That was weird, I think to myself.  I put in an order for x-ray of the hand and wrist.  I put that plate up in the air to spin, and move on to: Chest pain, Migraine, “Can’t see,” Sprained knee, “Menstrual,” “Sick still,” Split lip, “Vag drip.” Jerry’s x-ray is done.  Wow.  He’s completely shattered his wrist and 4th and 5th metacarpals in his hand.  I haven’t seen a one this bad in a long time.  I walk into his room.  “Jerry, you’ve badly fractured your hand and wrist.  You’ll probably even need surgery.  I’m going to call the orthopedic surgeon.” “No.  I want you to fix it.  You owe me, big time,” Jerry says. “No, you don’t understand.  It’s badly fractured.  You need a surgeon for this, a specialist,” I explain. “Did you hear me?  I said, ‘NO ’,” he says, gritting his teeth so hard they could shatter. After years of seeing anything from little old ladies to psychopathic criminals, it takes a lot for a patient to truly bother me, but this guy is truly disturbing in a way that’s hard to describe.  It’s time to get out of this room.  “That’s the way it has to be for you to get the best care,” I say and walk out of the room. As I get to the door, he yells, “This s—t is your fault mother f—-r!  You should have called me back.  I left my cell number on the letter for a reason.  YOU shattered my hand and wrist.  This is because of ...

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Got A Light?

By Birdstrike MD I walk into the ED for the 7:00am shift.  I’m 24 hours post-night shift so my body thinks it’s 3:00am and my brain feels like it’s been embalmed for 3 days.  I take my last swig of triple dark-roast Starbucks and sign up for my first patient. Chief complaint: “Lost light” Is that a misprint?  Maybe it’ll be a quick and easy one to start the day, I think to myself.  That’s just what I need, so my coffee will have some time to kick in.  I’ll just send this guy off the Lowe’s or Home Depot, I laugh to myself, so he can get a new light.  I walk into room 13 and there’s a man laying in a fetal position on a stretcher, with the bed sheet over his head.  I walk up to the side of the bed and say, “Hello sir, I’m Dr. Bird, what can I help you with today?” “Well, doc, I’m in a bad spot.  I was holding on to a light bulb, and it just popped right in,” he says with a whimper, avoiding eye contact.  Looking at his face, I notice he is as white as the bed sheet.  He’s pale and looks like death. “What are you talking about?” I ask him. “Lift up the bed sheet,” he says, looking behind himself. I lift the bed sheet and he is lying in a pool of blood.  The back of his gown is soaked.  I glance up at the blood pressure monitor and the automatic cuff had just rechecked his blood pressure: 88/58.  “Sir, are you having rectal bleeding?” I ask. “I guess you could say that.  The light bulb just popped right in,” he says again. “What?  Oh…I get it.  You mean…you, put it up your rectum?” I ask, now knowing exactly what happened.  For an ER doctor, things like this are not shocking.  In fact, they are part of the portrait painted for us every day; the bell curve of the ER doctor’s experience. “And it popped!” Ouch, I think to myself.  O U C H !  “It broke?” “It exploded in there,” he cries.   2 IVs, bang! Fluid bags hang. Time to call the OR gang. KUB ordered, Let’s see the x-ray. “Am I dying, Doc? Is this my last day?”   There it is on the x-ray: one homicidal light bulb clearly visible inside one rectum cut to ribbons, with its countless shattered glass shards, doing their best to bleed the life out of a man. “Am I gonna make it doc?” he asks me again. “You’re going to make it,” I answer.  “You got yourself here quickly.  If you had waited any longer, you might not have.” “Doc, can you please tell my wife…” “Wife?” I interrupt, surprised. “And my kids…” “Kids?” I ask. “Yes, doc, we’re here on vacation.  It’s our first family trip to Disneyland.  You wouldn’t understand,” he says, as he pulls the bed sheet over his head, as if to crawl under a rock to hide and never come out. Just then the OR team barges in the room commanding, “We’re ready for him.  Let’s go!” “What do you want me to tell your wife?” I ask him. “Doc, please, a hemorrhoid.  Just tell her it’s a little hemorrhoid.”   ………………………………………………………………………………………………………………………………………. This author does not divulge protected patient information or information from real life court cases. Any post that appears to resemble a real patient, real person, real co-workers or trial can only be by coincidence. This author does not post, has not posted and will not post factual identifying information ...

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Why Patient “Satisfaction” Could Be Making You Sick

By  Birdstrike MD All patients should be treated with professionalism and respect.  We all want our patients leaving our care happy, healthy and satisfied, if at all possible.  However, sometimes patients don’t leave an Emergency Department very happy or satisfied.  Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the treating physician did, or didn’t do.  The reasons for a patient being dissatisfied with a particular healthcare encounter can be very complex.  It’s not so simple as to just include a line in a survey such as, “Were you satisfied with your doctor?”  Who should be held responsible for the results of these surveys, is where the crux of this debate lies. So why are Hospitals obsessed with “patient satisfaction”? It’s the same reason Walmart puts greeters at the front door (the ED), not the back door (in-patient floors) and the same reason the Government collects taxes and not sea shells: Money.  The question we really need to be asking is: Why is the obsession with patient satisfaction in the ED so soul-crushing to those that work there?  1-Lack of Control A patient pulls into the ED parking lot.  The lot is full.  He doesn’t feel well, he’s in a hurry and having to search for a parking spot irritates him.  The wait to see a doctor is long, too long.  Once finally in his room, he sees a drop of blood on the floor from the previous patient.  He’s disgusted.  Despite great care by the doctor, it biases his overall view of the experience.  As much as he tries to remain objective, the patient satisfaction score suffers.  The patient gives a “1 star out of 5” review after discharge, but writes in the comments, “Doctor and nurse were great, though!”  The tabulated score remains 1/5, or “FAIL.”  The doctor gets pulled aside at her next group meeting and is told she’s on watch due to low scores.  She’s never been fired from a job in her life, but now her job is in jeopardy, over something which she has no control. A patient leaves an ED satisfied.  He gets a patient satisfaction survey and throws it aside.  He has no need for it.  The visit went great.  It’s his preferred hospital for anytime he gets in a bar fight and needs to be sewed up.  He got in, got his knuckles stitched, and got a free Sierra mist and a meal tray.  On his way out the door, he tweets, “#CityGeneralERrocks!” on his smart phone to the world’s prospective ER “customers.”  Six weeks later, all has healed well, and there’s barely a scar.  Then, the bill comes.  “!&@!?#€!!!,” he thinks.  “$920?  Screw that place!”  He grabs the survey and nukes the hospital, doctor and nurse all with the lowest score possible.  He writes in the comments, “I would have rated you a ‘negative infinity’ if the scale went that low!” You can save a life, walk out of the trauma bay drained but proud, and be pulled aside and told that on last months survey, you didn’t get a patient a coffee “like they do at the car dealership.”  You are told, “Get those scores up.  Administration is watching.”  It translates into, “You suck.”  It’s not that big of a deal, right?  Maybe you should brush it off, but you are human.  You haven’t “evolved” to the “new way” yet.  You’ve heard of ER doctors losing their group contracts and therefore their jobs over things like this.  It bothers you. There’s a complete and utter ...

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