The Red Line To Our Personal Hell

I spent last night working at Washington Hospital on the northeast side of the city. In doing so, my travels took me aboard the red line Metrorail. I have found my time on the Metro to be an opportunity to reflect on the day. Grant it on the way back from the hospital this morning my time was mostly spent just trying to stay awake...I stood and watched the buildings in the crisp morning's sun. Irony of Washington Monument being in the same field of view of run-down housing can really put a spin on your day if you let it.So last night I worked in the Emergency Room (ER) or Department (ED) (pick your poison). Now that the shift is over I can say this, it was a surprisingly, relatively quiet shift. I worked with a really cool attending physician. The guy sincerely cares, which tends to be the theme around here, mind you. He and his staff worked hard to teach me, which was great in itself. He allowed me to do as much as I want to do, so I was prepping patients in no time flat. Fortunately, I will be working with him throughout the rest of the semester. Last night, I saw a lot of different diseases. What sticks with me through all the minutia is mostly the images of scared patients. Fear rests on our shoulders and grabs at our throat, perhaps one of our most important signs of humanity. I feel as long as I can identify with the fear associated with each patient, whether he/she be conscious or unconscious, dead or alive, sick or healthy, I will be guided. Things become complicated when drug addicts faking pain looking for a score, child/spouse/elderly abusers, individuals trying to get out of work, or looking for a reason to sue, etcetera enter the mix. Patients can have 10 of 10 pain no matter how bad it really is, which is frustrating but also very enlightening. Patients can be extremely scared despite what their disposition 'looks' to be, and fear can drive a person to do many things they normally wouldn't do. The patient with the perirectal abscess in Room 10 may be a jerk to everyone. He may be homeless. However, he needs help, so you jock up, try your best to overlook the fact that he is practically screaming at you, because he has had to tell the same story 4 times in the last 4 hours. By the way, waiting times of four, five, six, seven (you get my point) hours are the norm for non-immediate life-threats in major city hospital ERs. The truth of the matter is that he has probably lived with a bleeding abscess for quite some time, but last night was pretty damn cold. So you tell me, if you were in his shoes, which would be an extremely difficult image to picture, then what would you do...cold night out with a slow bleed in the area where sun doesn't shine or a warm Emergency Department with a bunch of questions thrown at you after a 4-hour wait followed by some medical student sticking you, swallowing some barium filled cranberry-like juice, and then being taken off for an image study and a likely surgery to fix a persistent abscess...oh yeah did I mention receiving a few meals. So, the Emergency Room is a place of battles. Some battles are fought and either won or lost in minutes, while other battles are almost purely ethical. The fact remains: people need help.