Fatigue, not just for the weary

February 29, 2016

Nothing makes me feel old like a night shift.

Even though I say that all the time to my residents, I think that ‘old’ probably isn’t the right word. I think that what I really mean to say is fatigued.

Fatigue (n.) fa·tigue \fə-ˈtēg\: 1) labor; 2) weariness or exhaustion from labor, exertion or stress; 3) tendency of a material to break under repeated stress

The tendency of a material to break under repeated stress. Nine A.M. after a long 12 hour overnight shift in the Emergency Department, I sit in front of my computer and stop to wonder if it’s possible for me to break under repeated stress. We hear stories of this or that ER doc who cracked under pressure and quit the field or the other ER doc who had a nervous breakdown in the ambulance bay. Eventually you start to wonder exactly how much repeated stress that might take.

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Survival of the Fittest

November 19, 2015

An observation that I and many of my emergency medicine colleagues have made about vacations: we need them. We need them for wellness, to recharge, to recover. Great saves, terrible tragedies, we witness it all and it can wear on you. Unfortunately, when vacation plans are made, it is not uncommon to find oneself working even more shifts before the break to offset our absence on the schedule, making the time away absolutely critical by the time it rolls around.

And so after ten shifts in thirteen days, I find myself exhausted, unprepared, nervous, on a hot, humid bus that is supposed to be taking us to the dock but instead slows unexpectedly. A land iguana, a golden brown ancient dinosaur, creeps off of the road into the side brush. Piling off the bus, we are directed toward a concrete platform adorned with huge lounging marine iguanas. I gather my belongings and catch myself from stumbling, nearly stepping on an iguana’s whiplike tail that seems to have appeared right next to me. It spits salt water at me in retaliation but does not move. Sally lightfoots scuttle along the jagged shore, red as the lava the rocks once were. When I ask which boat is ours, I am interrupted by shouts of “Blue footed boobie!” causing me to forget the question I just asked. This is the first hour in the Galapagos.

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The leaf blower/CT scan quandary

December 14, 2014

To critics who admonish emergency physicians like myself for our excessive use of CT scans, I’ll ask them to consider the leaf blower. I’m sipping my morning coffee on our front porch, a bright, idyllic autumn day in New England, the tranquility ripped apart by the landscapers across the street. For many jobs, a powerful leaf blower might prove superior to a rake or broom. But in my neighborhood known for smaller yards, the humble rake and broom would work as well, if not better.

I’m not a leaf blower person. Raking my yard takes hours. It leaves my muscles knotted and hands calloused. Not so the speedy landscapers, nonchalant with technology strapped to their backs. Laughing and screaming over noise that assaults my eardrums, they bully grass clippings and leaves into a dancing cloud that swirls onto the street, often finding refuge on my lawn.

Why should the status of lawn detritus, or my serene coffee moment, concern them? They’re responsible for my neighbor’s lawn, not the yards nearby. And if leaf blowers improve the speed and perhaps the quality of their work, why wouldn’t they take advantage of the opportunity? Imagine the following argument from a landscaper-philosopher: “What is a leaf blower anyway but a push of air, like a strong wind? You have a problem with the wind?”

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In This Life

November 24, 2014

“Mom!  Mohhhhmmm!  MAMA!”

I’m on a deadline. I work the overnight shift tonight. And I’m presenting M&M at our staff meeting first thing in the morning. My powerpoint is nearly finished.

“WHAT, honey?”

“Well . . . what are you doing?” He’s rocking his head back and forth, something he has done out of comfort since he was a baby.

“I’m working on a presentation for work.”

“What’s it about?”

“It’s about a man who was very sick. He died. He had a heart attack. I have to talk about it with the other doctors.”

His head stops rocking. Maybe I shouldn’t have told him he died. Have I ever explained a heart attack? He looks into my face. Here it comes. How do I explain this to a six year old?

“Was he very special to the world?”

My breath catches. Read the rest of this entry »

Putting It Away

September 25, 2014

I set up the laceration tray, sterilized the man’s face, put on my mask and size six gloves, and leaned forward to anesthetize the gash. The patient recoiled from me. “You are NOT putting that needle into me.” He had been drinking. I looked over at his girlfriend, sitting against the wall. She met my gaze and raised her eyebrows pointedly, as if to say, ‘Deal with it yourself.” Read the rest of this entry »