Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He’s forwarded a letter of concern from a specialist from a different hospital. It’s about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick up the phone and tell him the story:
It’s Friday night. 10 p.m. I have the overnight shift; the one that’s supposed to start at eleven, but I’ve been called in early. Very early. It’s standing room only on my way to the Rapid Assessment Zone (RAZ) — and heads look up as I pass — parents holding children in blankets, adults hovered over barf-buckets, elderly people leaning on their walkers. The evening doctor is tied up with a car accident, and an hour earlier, he’d broken my sleep, asking if I’d come as soon as possible. Just as I’m about to enter the RAZ, a middle-aged woman yells out: “I need something for pain!”
The stack of charts is thick. I leaf through — dizzy, abdominal pain, chest pain, headache — the usual. A nurse emerges from behind a curtain and hands me an ECG: “Can you see this one first? Chest pain, shortness of breath, since six o’clock.” The ECG is fine, but in matters of the heart, time is tissue, and he’s been triaged ahead of the others. I talk to him, examine him, and order blood work — telling him he’s likely fine. Minutes later, I’m scanning the next chart when another nurse discreetly points into the hall and lowers her voice: “The woman in the wheelchair is in pain. She’s making a scene.”
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