Viraj's Weblog

I'm not a big fan of the various medical TV shows, but I do like books written by doctors. Recently I read Something For the Pain, a really good account of one doctor's experiences in the ER.

Here are some quotes I like. This one is about dealing with drunks:

But other drunks, the ones who've gotten in fights or wrecks trying to outrun the cops, are combative, angry, dangerous people. And we all know that the same guy who spits at you through bloody lips and calls you motherfucker will be sober when he sues you if there's a bad outcome in his care. In court, his face will be freshly shaved, his hair carefully combed. He'll be contrite for having been intoxicated. His lawyer will be baffled by the way doctors let him injure himself while he was incapacitated.

To let hostility show is a failure. A failure of boundaries, a failure of self-control. If you counted on human compassion to keep you from smacking one of these guys, you'd be in trouble by the third day on the job. And if you let them get to you to the point where it shows, you have no business being an ER doc.

And he goes on later about making the decision to send to rehab or not:

If I had my way, we'd just total up the costs: rehab, trauma, and medical care. Then tax alcohol sales accordingly. Let the cost of a six-pack or a bottle of wine reflect the true cost to society. Use the money to pay for rehab. But I don't have my way. I'm just the guy who has to ask an alcoholic or a crack addict if he has insurance.

The type of patients in the ER of course vary quite a bit:

The polar symmetry of the two cases struck me, and I hesitated before picking up the next chart. I went to the bathroom, and splashed my face. They lady with the head bleed was going to the ICU, stuck on a respirator, not quite dead, not quite alive. I thought about the teenaged girl with the tiny fetus being squeezed out by the thick fist of her uterus. Of course, this fetus was doomed, just like the woman with the head bleed. The cells may have still been physiologically active, the mitochondria still as busy as the pistons in the engines of the Titanic, the heart still pumping furiously, but futily. For both the forty-three-year-old with the brainful of blood and the tiny fetus, death was only on hold.