I have not found the time to write in my blog since I started over at UCSD emergency. It is kind of what I had expected, but about 10 times harder than I could ever have imagined. I am barely keeping my head above water. I am juggling so many patients and feel pulled in so many directions. I can understand how other services get frustrated with the emergency department because I honestly could work up patients much better if I could focus on one at a time, then move on to the next one. It doesn't work that way.
For example, I have 5 patients, I have been on for 1 hour so they are all at the beginning of getting worked up. A patient comes in with afib with rapid ventricular response hr 200s, tachypneic, short of breath. I am pushing drugs trying to get her HR down. Have just instituted diltiazem drip, when "stroke code 3 minutes" patient comes in with acute stroke, so I write hurried orders on my afib lady and rush over to stroke guy. Meanwhile, guy off the streets comes in short of breath, tachycardic, with diarrhea. I need to go evaluate him for COPD, CHF? Pneumonia?. Then there is my back pain guy in the back who needs discharged, and my anxiety lady who wants me to go calm her down. Not to mention the sore throat that who knows when I will see, and is getting progressively frustrated. So this is what I signed up for right? I am good at multi tasking right?
Damn. It is so hard. I feel like the emergency department is a set up for disaster. It is so easy for a mistake to be made.
Maybe I am just justifying the mistake that I made. I can't get it out of my head. I had a homeless guy who didn't look that sick when I signed him out to the next team. New onset CHF but BP 158/100, tachy 105, tachypneic 24, 02sat 100% room air. He did have white count though, and what looked like renal failure. No known infectious source. So the typical conundrum, heart failure vs sepsis? So I ordered antibiotics, cards was going to see him and do an echo.
The next day I hear he coded twice and is intubated in the ICU. Then the kicker. He is allergic to penicillin and I gave him an antibiotic with a type of penicillinin it. I haven' been able to get it out of my head since I found this out. Such a simple thing to look at allergies. I have a hard habit of asking allergies as my last question on all patients, but I don't rememer asking him, but on his chart it clearly says penicillin. I didn't catch it, pharmacy didn't catch it, the nurse didn't catch it, he now may have very well had a reaction. It is hard to say though, he was not doing great based on his labs so may have been heading down anyway, but I have felt sick since then. In fact, I have been seriously considering my decision to stay in emergency medicine. He is a sick patient, that I know how to take care of but being pulled and tired I just simply made the easist mistake.
I enjoy stabilizing critical patients, but wonder if I am ready to really go through this again and again. I think I will never again give a patient a medication he has known allergy to, but working with limited information, limited time, it seems a set up for disaster after disaster.
So I don't know how to go about looking for a different or new specialty, or trying to reinvigorate everything that I thought I loved about emergency medicine. Right now I feel so tired, defeated, and not sure I am up for this the rest of my life.
