Few weeks ago, I have to cover for another physician who had an emergency and I agreed to help him out.Its on a friday night.I had a busy clinic during the day and as soon I am done seeing the patients I went home,changed cloths and spent few mins with my wife who was mad for working on friday night that I promised the week before for a movie night. I needed some caffeine in my blood to get me back to work.I filled up a big mug of freshly brewed coffee and drove off to Mena for an exciting night.After around 90 mins of driving, I finally reached Mena. All through the way while enjoying the beauty of spring blossom and lush greenery I kept thinking about how the night is going to be. Having worked on weekends before I know it's going to be a busy night,but it's the surprises that come through the door that get me thinking.By the end of the journey I am ready for whatever come through the night.as I parked the car and walked through the back door, I was hoping to see a hoard of patients charts waiting for me to be seen.
To my utter surprise there weren't any.infact the outgoing doctor has just finished admitting the patient and other transferred out.so I am here with no patients to see now. That never happened and it's a pleasant surprise I went to the doctors room and laid down for a few mins knowing my luck is going to run out soon.As expected the phone rang in 20 minutes and nurse told me that I have patient to be seen while they are fixing to bring another patient in. I went there and saw the first patient,an easy one,an elderly gentle man with abdominal pain.while waiting got the workup I saw the other patient,a small kid with an ankle injury after falling down from horse back.It started out as a trickle and within the next 2 hours the flood gates opened and I saw 8 patients.By this time,my mind is tuned to mechanical mode. I look at the chart to see why the patient is here and see him/her and order labs and medications before going to see the next one. 7 patient rooms and one trauma room are filled with patients.It continued through the night with patients coming with various complaints of chest pain, broken limbs, head injury, altered mental status, minor cough and cold and occasional one or two who just want to score some pain medication by complaining of pain somewhere and hoping that they can fool the nurses and me to believe them.
After caring to the needy and disappointing the pain medicine seekers away ,I started working on a patient who was brought in few minutes back following ATV accident. After seeing the patient and stabilizing him,I ordered imaging studies and went about to see the other patients.I grabbed a chart of room 2 and walked in to see a middle aged obese lady with artificial leg on one limb and a big wound on the other leg. After introducing myself I asked her name and other details about the gaping wound .She told me that she lives by herself in middle of a forest about 30 mins from the nearest road . She raises sheep there. She told me that couger was killing her sheep and her dog got in to fight with the couger few nights back and she went out to help the dog which was hurt by the couger. She was bitten by one of them and she didn't realize who it was as it was in middle of night.I was shell shocked listening to her casually telling me that she was bitten by a couger or her dog in the middle of night out of nowhere a week ago.I started looking at the wound on the only leg that's left. There is a gaping wound on the calf with swelling surrounding it. I asked her why it took so long for her to seek medical care. She told me that there is no one to take care of her sheep or dogs and she has been cleaning the wound and applying some antibiotic cream that she had it. She wasn't planning to come to ER,but after she noticed swelling and pus coming out of the wound two days back she decided on showing up. Its around 2 in the morning and I was with this lady with one leg thats bitten by a couger. I thought to myself why? Why in the middle of the night did she think of coming to ER after waiting for 8 days. I couldn't hold my slight anger(frustration)and asked her.Ms. So and so told me that she and her husband were seperated and that her ex husband agreed to come and bring her to ER after getting off work.
As I started working on her wound I realized that her self treatment with daily cleaning with soap,peroxide and dressing kept the wound from extending to underlying muscle.although the wound is around 5-6 cm deep,It only stayed in the subcutaneous fat that this pt has in excess all over the body. I debrided the wound and took off the dead tissue. By the end of the procedure,I was tired and sleepy .To keep myself awake I asked her why she is living in middle of nowhere as I couldnt help but notice her her language devoid of thick southern accent.She started telling me her story,while I worked on the wound dressing. She was from california and her ex husband was from Florida. They met through online dating way back in late 90's. They decided to get married and settle down. But where to settle down was an important question for them.Both wanted to settle down in a rural area away from the urban area where they grew up,but weren't sure where to go. They came up with an idea of rolling the dice on the Map of USA. She wasnt sure who got the idea and whether alcohol was involved or not. Anyways they rolled the dice and it landed in the middle of Quachita mountains. So they decided to move there.They brought 40 acres of land in middle of the forest and lived together for 15 years.They raised sheep,vegetables and other things. Unfortunately things didn't turn out well and they separated few years ago. While her husband moved out, she stayed back and continued to raise the sheep and live by her self.they still stay in touch and are good friends.
By the end of her story I was spell bound by how her life took turns,all starting after rolling a dice.I asked her if she ever thought it was right idea.With out hesitation she said "no". She said she enjoyed most of the time living like that but her recent health problems including diabetes complications leading to ampution of her left leg and having to live by herself,she doesn't think she can stay there for a longer time.I thought about her free sprit and mental strength to keep going and wondered if I ever could do that. I realized I am too accustomed to material comforts that I am complaining about seat warmer in my car.
I told the patient that she doesn't needs to be admitted but needs oral antibiotics and should follow up with her doctor in one week. She was worried and wanted to know if she needs to be admitted. Her ex husband dropped her and went back to take care of her home. After explaining her how to take care if the wound and no need to worry she agreed to go home.while she waited for her husband to drive back and pick, I started working on my trauma patient who had enough alcohol in his blood,that kept his pain well controlled.he fractured his left forearm. The last few hours of the night kept going with patients and finally at 6.30 I was able to clear the ER. I am so ready to go home and sleep. But I have another 90 mins of travel. After pouring myself another big jug of coffee, I rolled out of ER. On my way I saw on the many dirt roads and thought about rolling the dice,but my seat warmer is too comfortable for me.
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