I slept for ELEVEN hours last night. For someone who normally gets 5-6 hours of sleep a night, that is a lot for me, and much needed! I am someone who naturally functions well with relatively little sleep, but that’s only when I am waking up and going to bed at relatively the same time each day. Once you throw in a mix of different work shifts, I get all thrown off. When I am super tired, I still function ok at work because my attention is focused on one thing, but outside of work when I am doing multiple things at once, I am an absolute disaster.
Do you recall my post when I drove post call from Chicago to Detroit to visit my sister who had traveled there for work (Early onset dementia from working nights)?? Oh my goodness, first I couldn’t find the sponges I had just bought and later discovered that I had stored them away in the produce section of my fridge. Then, I was 15 minutes out of the city when I realized I left my wallet at Starbucks. Then, I was cursing at the toll collector on the highway, because it wouldn’t take my money, which I then realized was because Dean had an Ipass. Ha.
Well, Saturday morning after my night shift, I had to pick up Dean at the airport. We were on the phone and he was telling me where he was, and I couldn’t figure out why I couldn’t see him. You know why?? I had driven to O’hare and his flight was to Midway.
Saturday night was my last night of this stretch of night shifts, and it was BUSY. Friday and Saturday nights, particularly in the summer, can be very busy in the ER, and it can be extremely frustrating. Why? I don’t mind being busy, but it’s frustrating when it seems like a lot of people getting imaged after 1 am are trashed and here for stupid things they did because of their intoxication. Do you know how much it costs to get a CT scan in the ER?? Ok, I don’t know the exact cause either, but it’s a lot. Every weekend, many people get CT scans of their head and neck because of drunken falls. The majority of them probably don’t need to get imaged, but there’s no way for the ER physicians to clear someone if the patient is so intoxicated and incoherent to make any sense. People who are intoxicated have “altered mental status” which people with head injuries do too, so the ER physicians often have no choice but to scan them to make sure. To me at times, it feels like a waste of healthcare dollars and physicians’ time, because it can delay the time it takes for a physician to see and treat someone who is genuinely sick.
You’ll have to forgive me for my venting and bitterness lately….working in the ER tends to make me bitter and hypercritical of society, and really, I swear I’m a caring person, it’s just that the stress and sleep deprivation can get to you….
There’s just two of us radiologists at the hospital at night, and we are responsible for reading every single piece of imaging that gets done at night through the ER. Plus, we have to deal with any urgent imaging that gets done from any of the tons of patients already admitted at the hospital, some of which are obviously very very sick. We also constantly get calls from CT or MRI techs regarding the appropriate imaging protocols before they scan an inpatient.
A lot of times, the ER’s ability to decide on treatment and their plan for a patient is affected by our diagnosis on the imaging they have ordered, so we have to try to read through the imaging studies the ER has ordered quickly so as to not back up the ER while still being thorough and not missing anything on the hundreds of images that are associated with each scan. This is while at the same time having to constantly take calls from residents on the floor and pull up scans/images of their inpatients.
Added to the stress is when you are reading a CT scan of a patient with a potential surgical issue, because these cases are often life threatening and what you decide along with the surgical team may reflect whether the person is taken to the OR or not.
So can you see why it can be frustrating in a high stress environment when we’re trying to thoroughly and efficiently deal with genuinely sick patients with urgent matters to have to take time and deal with the stupid actions of intoxicated people? Then there’s numerous other scans that get done that may not need to be ordered at that moment but get done anyway because of the litiginous environment we all have to work in today. It’s easy for us in radiology to point fingers at the ER physicians and get annoyed at studies they ordered that may not seem necessary to us, but they have to work in a high volume ER with tons of patients they are seeing for the first time. There’s hundreds of people they must evaluate, make decisions on, and treat quickly while at the back of their mind knowing they could get sued for any potential thing they miss. If there is going to be health care reform, tort reform MUST be a part of it. We as physicians are ALL affected by the fear of getting sued.