Changes in E.R. Medicine

One of my E.R. colleagues came up to me yesterday, leaned against the wall, and told me he’s retiring next year. 

“I’m sixty-seven years old; I’ve worked long enough.”

“What will you do?” I asked.

He shrugged, gazing out to the treatment area where a dozen patients waited his care.  “I don’t know.  I feel like I’m falling off a cliff.  How do you give up the only thing you’ve ever done, what you love more than anything in the world?”

It’s true I love being an emergency physician, often proclaiming “I’m saving lives and stamping out disease.”  Though the work isn’t physically taxing, this coming year I’ll turn sixty and I feel my age.  Working three or four consecutive twelve-hour shifts leaves me considerably more exhausted than when I started practicing thirty-five years ago.  Medicine has changed in those years; we used to typically treat five to six patients an hour, now we average about two to three.  Huge changes have occurred in diagnosis, treatment, and testing.  When I was in training, my medical school in the Houston Medical Center had one of the first operational CAT scans.  For the first two decades of my career, one couldn’t order a scan without getting permission from the head radiologist or neurologist.  Now it’s routine to order several CAT scans every shift.  The E.R. chart used to be a single 8 x 11 sheet, a few scribbled notes was all that was needed, now it’s a computer generated book.  When I began, cardiac care units didn’t exist, and ICUs were reserved for the incredibly ill or injured.

I’ve given up doing some procedures; applying casts, draining fluids in joints and bellies, and intra-cardiac injections (medication shot directly into the heart), though as an E.R. doctor I still do intubations, spinal taps, and joint relocations.  Diseases have changed.  Over the past dozen years staph abscesses have bloomed from rarities to everyday occurrences.  Meningitis in infants has almost disappeared.

I doubt I’ll still be working full time as an emergency physician in another eight years.  But I’ll still be a doctor; perhaps more missionary work, or volunteering at a clinic, or doing fill-ins at slower facilities.  Meanwhile, I do have another life.  I write.  I’ll write about medicine, and about life, and how getting older is just a transition, not a cliff.

I’m going to work on my non-fiction book in 2013, “Thirty-five years as an E.R. doctor.”  There’s so much to write, incredible changes, remarkable memories and changes in attitudes and care.  Until then, I’ll continue to work … to save lives and stamp out disease.  It’s what I do.

By the Book or By the Brains?

There are two ways of practicing medicine, “By the book,” or using your brains.  Though they’re not mutually exclusive, they usually end up at the same point, albeit, with different courses.  This example is not recent, names are changed as are details.

Mary Smith came to our E.R. complaining of pain in her right leg.  She told the E.R. doctor (not me) she had a history of blood clots in her leg and that she was on Coumadin.  The E.R. doctor checked her blood thinner level and found her blood to be appropriately thin.  (Normal “INR” is 1.0.  To be therapeutic with blood thinning on Coumadin we like to have the INR at 2.0-3.0, or 2 to 3 times thinner than normal.  Hers was 2.5, perfect).  That was the right thing for the E.R. doctor to do.  He sent her home.

Her pain didn’t get better, so 2 days later Mary went to one of the walk-in clinics.  The doctor there told her she probably had a blood clot and sent her back to our E.R. with instructions to get a Doppler study for blood clots.

I told her she didn’t have a blood clot.  Her history (a burning sensation over her entire leg, mostly in the back, that turned into an ache) was typical of sciatica.  Her leg didn’t have any signs of a blood clot; no swelling, no change in color or temperature, normal pulses, and no calf tenderness.  I told her she couldn’t have a blood clot because her Coumadin level was high enough to prevent any clotting.  I told her I wasn’t going to do the Doppler, because even if she DID have a blood clot, since she was already on a full dose of Coumadin, there was nothing more we could or would do about it anyway. 

She wanted to know why the clinic doctor had sent her to get a Doppler.  Because, well, read the first sentence of this blog.

 

The Doctor Is In

At the New Orleans Heather Graham Writers Conference this weekend I pitched to seven agents.  I have this marvelous novel manuscript, “Andrew Comes Home,” a mainstream contemporary fiction that won first place in the 2008 RWA in New Orleans, first place and the contest’s Grand Prize at the Dixie Kane Classic in 2010, and in 2012 a second place in mainstream fiction at Florida’s Royal Palm.   It’s a well crafted, meticulously written, compelling read.  I’ve pitched it repeatedly at various conferences, in query letters on line, and in person whenever I could.  At this conference I received a collective ho-hum, two of the publishers agreed to receive it via email attachment, no guarantees they’ll even read it. 

Each interview lasted ten minutes.  I began with a pleasantry, and proceeded to draw out from my bag a stack of credentials; my beautiful children’s photo books,  the “Rocking Chair” anthology, some write-ups of my accomplishments, and some of my own magazine publications.  With the groundwork laid, I launched on my manuscript presentation.  Only once did the reception change.  One of the agents while thumbing though the magazine publications I handed her latched onto the article I wrote about my missionary trip to Kenya for the state medical journal.  “You were the first doctor there in twenty years?”  I admitted I was.  THIS is what she wanted, the story of my missionary work. 

At the end of the conference I was schmoozing with one of my fellow authors.  Well, I’m being bold to imply I’m anywhere NEAR the level of Jonathan Maberry as a “fellow author.”  He’s a New York Times Best Seller, has 25 books to his credit, and a movie contract in the works.  (http://authors.simonandschuster.com/Jonathan-Maberry/67600213)  (http://www.goodreads.com/author/show/72451.Jonathan_Maberry).  He said, yes, no doubt “Andrew Comes Home” is a good book.  But there are tens of thousands of good books out there.  My brand needs to be about my medical journeys; my E.R. stories, my mission work, my unusual adventures including being a medical examiner and music festival physician.   Once I have those books ready I can make a three book deal to include “Andrew.”  He suggested everything I write should include “M.D” on my byline. 

I suppose he’s right.  People CARE about the M.D.  Up 'til now, I’ve always thought of my writing as separate, reserving my M.D. for those areas where it belonged, treasuring it rather than commercializing upon it.  Still … if I want to get my writing noticed, perhaps I should give this another thought.  It’s a personal decision, a big shift in my perspective, and one I think I’m not ready for. 

Yet.

Heather Graham's Writers for New Orleans Conference

I’m attending my third writing conference of the year, this time the Heather Graham presents Writer’s for New Orleans.  www.writersforneworleans.com.  Every conference has its unique flavor.  I loved the Florida Writers Association in October that featured four sessions at a time, educational lectures focusing on improving your writing; such as character development, poetry sessions, or social media info.

In contrast the Heather Graham has only a single session at a time, all featuring successful published authors or agents in panel discussions giving real tips on being a professional author.  In both cases the attendees included a high percentage of novice writers, but in this conference the ratio of successful authors is much higher, and with the smaller attendees there’s a lot of opportunities for one-on-one discussions of their success stories.  I’ve found I’m where I thought I was on the professional level; above the beginners but nowhere near the professionals.  With my eleven books and dozens of articles I’m certainly somewhat established, but there are authors here with twenty books, with 500,000 copies sold, New York Times Best Sellers, and they’re very personable.  Conferences.  Yep, if you’re going to be a writer, it’s where you should go.