Friday, May 28, 2010

Warm Weather & A Full Moon

Time and time again, I hear references in our ER about how our crazy, hectic pace is tied to the cycles of the moon. "It must be a full moon," people say, as if every explanation to being overwhelmed and underappreciated in the ER is somehow aligned to that beautiful bright, glowing circle of wonder that hangs over our heads several evenings a month. I remember driving home many a nights, though, from an ER shift where I've gotten a spanking, only to look up and not find the moon guiding my way.

The other reference? Warm, hot weather. "It is so nice outside today," some staff will say, "it's no wonder we're getting slammed." Again, the thought is that warmer weather promotes more outdoor activities and more buzzing humans which, in turn, promote an increase chance of injury or illness. We do live on a lake, yes, but I can't even remember the last trauma I've had that involved a water-sport activity. I do remember, though, the numerous heart attacks that were a result of patients shoveling three-feet of snow during our cold, windy winters.

After four years of being a resident and thirteen years of being an attending, I have learned that there is only one truth about an emergency room's busiest moments.

Are you holding on to your hats? Ready for the big revelation?

The truth is...there is no rhyme or reason to when the ER might be busy.

Most people assume that Fridays, Saturdays, and Sundays are the worst days to visit an emergency department, that we are at our busiest. Honestly, though, in our ER, Mondays are panning out to be impressive for both the long waiting-times and the quantity of patients coming through. And Tuesdays are coming pretty close to Mondays' craziness. The thought that an ER is less busy in the winter months compared to the summer months is just that--a useless thought. And morning times are supposed to be less congested than evening and night times but, again, I wouldn't hang my hat on that. Many times, I've come in for a morning shift only to find the ER clogged with waiting patients.

So, this is the reality. Every time you go to an ER, you just don't know what you are going to find. It may be slow on a Friday night, and it may be crazy at 3:00 a.m. on a Wednesday morning. But another truth? It is what it is, plain and simple, and a patient yelling and carrying-on about his long wait will not get him seen any sooner. Louder does not make you flow through our system any quicker. Nor does it make you any friends. And calling your family doctor, the one who promised that if you went to the ER 'it will be a quick visit', will not push you further ahead in the waiting line, either. Sorry. That is something you'll need to take up with him.

I'm very matter-of-fact about the whole thing. And I'm certainly not complaining. I signed up for this job, as did the rest of my comrades, and we will all continue to do our best and give 110% of ourselves. We always do. Sometimes, though, on some of the worst days, I wish I had a magic wand to wave over our backed-up ER and start anew.

A few shifts ago, I arrived to work my evening shift (from 6 p.m. to 2 a.m.) only to find that there was a four-hour wait to be seen and approximately twenty-five "angry" patients hanging out in the waiting room. Soon after, unfortunately, we got a motor-vehicle accident with four trauma victims brought to our trauma center for life-saving treatment. As you can imagine, this pushed the number of waiting patients and the waiting-times even further back. Add in the occasional stroke patient and cardiac patient, and you can see where this shift was heading. Despite having 36 treatment rooms and a full staff, we were extremely busy. Organized chaos, I always call it.

By midnight, the wait time was almost six hours. Thirty-five people were still waiting to be brought back to a treatment room. I was told the waiting room was becoming a potpourri of angry incidents. People were starting to lash out. Besides getting our security team and the police in place, what else could we do but keep plugging along.

You know how it feels to return to work after a week or two of vacation and see the pile of work awaiting your return? I think I would liken that feeling to how we all feel during a shift like this. The workload was endless. Despite our best efforts, it was simply one step forward and two steps back.

But, as I knew it would, 2 a.m. did arrive. It was my time to go home. But did I? Hell, no! For the overnight, our ER had one of my partners and one PA scheduled. Hardly enough man-power to provide care. I checked out the patient-waiting list. We were now 38 patients behind. UGH!

I stayed for three extra hours. I could never leave a sinking ship no matter how tired I was or how much I had been kicked around already. By 5 a.m., however, our waiting time was down to three hours and there were only 15 people waiting to be seen. The new, fresh morning team would be in at 6 a.m. And I was at a lull between waiting for results to return on my current patients and for the nursing staff to bring back more new patients.

It was the perfect time to escape.

I found my partner and asked him if he was okay...if he needed any help with anything. He didn't. He graciously took my sign-outs and before I knew it, it was 5:15 a.m. and I was driving home.


I opened up all of my windows and my sun roof and enjoyed the brisk nighttime air as I drove along the lake. Minutes later, I drove by a Tim Hortons and did a u-turn. I parked the car and ran in and got a dozen of my kids' favorite doughnuts for when they woke up in an hour to go to school. If I couldn't be a hero to 38 waiting room patients, I would sure be one for my kids.

As I walked out of the doughnut shop, I looked up. And there it was, glaring right at me--the sky's full monty. Suspended in the clear, dark night among some twinkling stars, the moon and its glow hovered over my every step. I was in a short-sleeve shirt and felt the swirling warm breezes of the night immerse me in their embrace.

That quickly, my center was reset.

Okay, I'll give. Maybe there is something to this full moon and warm weather business after all. Yes, it was warm. Yes, there was a full moon. And, finally, yes--the ER was swamped with patients. That was probably the busiest I've seen our ER in a while.

But, at least it wasn't a Friday, Saturday, or Sunday...

Hey all. I'm working a string of six shifts and it has been crazy-busy, so I'm sorry for skipping Wednesday and today's late posting. I'm whooped and go in for the last one tonight. On a good note, I spotted another double-crack last night! Yes, two in that many months!!! But, no can do...LOL. As always, thanks for reading. I hope your Memorial Day weekend is a safe one spent with those you love. See you next week.


Kate said...

When I worked with teenagers, I swore by the crazies of the full moon. But now that I look back on it - there was no rhyme or reason to the crazies. But the full moon was an excuse to give myself a break for having a classroom of unruly teenagers out of control!

Enjoy your weekend, when you get off tonight.

Jacqueline said...

That's crazy, but I'm the same way...I'll stay for hours on end to help others, in some cases even when I know they wouldn't reciprocate. I just can't bring myself to leave someone screwed...and sometimes that ends up screwing me.

But yeah...get some rest :)

Stephany said...

Oh yes, it's true. The psych wards admits increase, (saw it myself as a visitor)and I had at least one of my kids on a full moon, also was in a near-fatal car accident on a full moon. I remember riding in the ambulance, and the techs telling me it was a full moon.

BUT, I also read people weigh less when there is a full moon above, so at least that could be a good thing!

Great Dad bringing home donuts!

DownDoggin in MN said...

I've had a few recent encounters with a few different doctors lately (moped accident in Mexico). After my experiences, I just wanted to drop you a note to let you know what a great doctor you must be judging by the feelings and stories you share here with your readers. I have such a different feeling after being treated by a caring doctor versus being treated by someone who sees me as something to be checked off a list. Your patients are very lucky to have you caring for them during what can be some very tough times. Keep up the great work in your ER and on this site, I always look forward to your posts. Have a safe and wonderful Memorial weekend with your family!

Jim (UK) said...

Take some time for you and yours ......

Katie said...

I'm exhausted just reading about your day. I suppose I can let missing Wednesday slide. Although, I was starting to get sad at the idea of missing two days in a row. :-)

I hope you have a wonderful weekend. You deserve one.

<>< Katie

Cal said...

Tim Hortons, lucky you! I miss having a Tim Hortons around the corner, now that we are in the West Coast. All the best, hope you have a restful weekend.

Kateri said...

Interesting that Mondays and Tuesdays are some of your business days. I'm a home care nurse and we were just told in an in service geared toward preventing ER visits and hospitalizations among our patients, that the days that have our agency has the highest number of patients going to the ER or being hospitalized are Mondays and Tuesdays..

MLee said...

I agree, Monday is normally our busiest day. We do daily flash meeting that is a quick review of what we saw the previous 24 hrs. On Mondays, we average between 225 -240 patients. Other days are about 30 to 40 patients lighter. For some reason we also have sicker patients on Mondays with more admits.

NurseExec said...

In my milieu (long term care), the staff is convinced that the full moon has an effect on our dementia patients. I don't buy it, though :)

Empress Bee (of the High Sea) said...

doc you really COULD take a photo of the double crack with your phone and not let them know it and not show who they are. we want to see! ha ha ha

smiles, bee

Jim Purdy said...

Thanks for the post. I've been guilty of sometimes getting impatient in an ER, especially if one of my sons had been waiting for what seems like many hours.

Anonymous said...

I hear you loud and clear! I work in social services, where it often feels like there's a never ending line of phone messages, in-office emergencies, and crisis after crisis... and then there are the on call days.

There's something comforting in the "full moon" justification. I guess even when you know that you can only move so fast and juggle so many cases, there's a feeling of responsibility for the persons waiting for long periods of time, even if you consciously know you do not control the circumstances. Attributing such crazy shifts to the weather, a full moon, etc... it's almost a way of releasing onself from those guilty feelinss of having to rush, people having to wait, extreme situations occuring etc... Or perhaps that's just me? :)

Hey now - just when did the US get Tim Hortons!?! As a Canadian, I'm shocked! :)

Please keep up this wonderful blog. Your posts are such a treat!

-Tessy (outted lurker)

Amy said...

Interesting, I wonder why Mondays are the busiest. It makes sense for a doctor's office, because they're closed over the weekend, and on Monday they get all the patients who got sick on Saturday or Sunday. But the ER is open seven days a week! Maybe some of those people who got sick on Saturday or Sunday and didn't (couldn't) see their physician because it was the weekend got bad enough by Monday that they ended up at the ER?

peace-sue said...

while I am always polite and patient, I must say that this did come back to cause problems during one visit to the ER. One of my co-workers cut her hand badly, but since she and I both have good first aid skills, we applied a pressure bandage, and she held her hand up over her heart and we calmly went to a nearby ER (that didn't specialize in trauma - my inside tip for cutting down on wait times). We were asked to wait, and then they were about to take us when the elderly gentleman sitting next to us complained of weak and dizzy and they asked us to wait some more. Well, this must have messed up their system because they then forgot about us, and until I went to check we sat there - the triage nurse apologized for forgetting us. I seriously thought that perhaps next time we should take off the bandage before we went in so that my co-worker would be bleeding all over the floor, so as not to be forgotten.

911RN said...

Mondays stink- one of our busiest ER days IF not the busiest- year round (as a rule). Agree 100%- there is no rhyme nor reason to an ER's "busy-ness." Can change on a dime...go from empty board to full board in 30 minutes- I've seen it happen all too many times!

Folks call and want to know if we are busy. We tell them we don't give out that info (if we are slow) because it may be entirely different by the time they get there.Oops, the dreaded "S" word-sorry, a veteran ER nurse knows better than that:).We WILL tell them if it is busy and approximate wait time- based usually on their "non emergent" complaint. They usually never show up, if busy! If you call to ask- it's not an emergency. It was a LWOT visit avoided (for us).

I think the full moon thing applies more to labor and delivery than the ER. Whole gravitational pull issue with babies dropping like rocks from the uterus and all.Now there's an image.

Warm weather- applies to us due to resort location/population explosion. BUSY all summer long.However, I can remember one summer triaging 40 patients in 4 hours! Nearly, half our our usual daily census for that time of year!An obscure day in mid June, not a holiday, mid week, good weather, good surf, no riptides- no rhyme nor reason for the rush. I had to call in reinforcements to get through the storm.

Sorry, you have been working so hard, doc. Enjoy your weekend off! Well deserved, sounds like. Yes, I looked early on Wednesday and Friday for posts (was disappointed but figured you were busy).Was glad to come home late Friday night (after 12p-12a shift) and see you had pulled through with late Friday posting:)

I never leave, either, if the ship is sinking! Stay over until a reasonable lull is reached, to get things caught up- then exit when time seems right. Just as you did.

Lastly, WHAT is a Tim Hortons? All I know- if it involves good doughnuts- I'm jealous! My #1 sweet weakness- should have been a cop:) We don't have a Tim Horton's but sounds like I'd enjoy one if it came to our locale.

Glad you are of my same opinion that doughnuts are an appropriate 'breakfast', for kids, before school- contains eggs and flour and milk...right? Those are nutritous and healthy foods- just packaged a little tastier in the doughnut!

TGIF you only mentioned the double crack and did not develop another full blown post- OMG- you are hung up on those-LOL! Too funny!

Thanks for the post- agree with your "ER revelation". Veteran ER staff know, all too well, your are absolutely correct, sir.

SeaSpray said...

Great Post Jim!

I have always felt like Mondays were make up day for the patients not going in to be seen over the weekend ..for both ED and OP. Busy day and evening. Wednesdays always seemed slower because docs off ..but weekends did pick up ..especially with certain things.,, bar crowd type stuff fridays and Saturdays. But I always said no rhyme or reason to it because you could get slammed any day or night or have time to kill.

I likened the ED people I worked with to M*A*S*H* ..when it was busy ..we all worked like crazy and when quiet ..they were all crazy. (with jokes and laughter :)

In the winter we'd get slammed because of all the winter things, flu, snow thrower accidents, usual stuff and slammed with skiers and snowboarders.

But warm weather brings out your embedded fishing hooks, skateboard injuries, sunburn and the usual stuff. And every so often the old .."I was slicing a bagel and ..."

Then the seasonal sports.

Full moon, warm weather and ordering Chinese food. :)

I love those balmy nights and a full moon and it's silvery light on the ground ..preferably with snow or on the ocean my favorite kind of night ..even more than a sunrise or sunset. Full moon nights are spectacular.

I'll bet your kids loved those donuts! :)

SeaSpray said...

Sometimes impatient patients would leave to drive a half hour to go to a usually busier ER and then soon after they left it was their turn to get called in.

Karen said...

I bet your kids were tickled to wake up to doughnuts! When I was a kid, my Dad bowled on Monday nites. Every Tuesday morning there would be 3 rolls of Lifesavers on the table, one for each of us three girls. You're making good memories there, Doc.

terri c said...

Good for you, bringing donuts!! I was on call at the hospital Friday night and the poor hospitalist was getting slammed, the cardiac unit was full, the ED was jumpin', etc. Kind of unusual night--several codes. OY!!! Happy holiday.

KateA said...

I am an ER vet. People get pretty irate when they have to wait, even an hour. They see the two people ahead of them and not the 20 ICU patients in the back room or the ones that are dying coming that don't usually come through the triage rooms, just straight back to ICU. There have been many times when I have wanted to introduce the complainer to the person that has just had to euthanize their very sick animal. How many people could look that person in the eye and begrudge the fact that they needed a vet to do the euthanasia consult, even though it took up 30 precious minutes of my time.

I had one person, a cat breeder, whose cat was queening her THIRD litter. She knew that it was going to be a dystocia case because the previous 2 had been. Yet she continued to breed this cat. Her cat's c-section was put off for an hour while I tried to save a dying trauma case.

The lady complained voraciously at work the next day. Just so happened she was a secretary in my sister's law office. This "lady" actually said I should have done her cat first because the other patient was obviously going to die anyway. Needless to say, my sister being a lawyer and the breeder being a secretary, this line of talk was shut down ASAP. But it does show you how selfish some people can be.

Trust me, you DO NOT want to be the focus of the usually means bad things are happening.

Rogue Medic said...

The full moon has no effect, but that does not stop us from believing in this effect. It seems as if it makes sense and gives us a feeling of being able to predict problems, but it is nonsense.

This kind of superstition is extremely dangerous. On a blog post about the magic of the full moon, I posted some links to research refuting the notion of a full moons effect. The owner of the blog apparently did not like the idea of being contradicted and my comment was deleted by the blog administrator.

Too many of us choose ignorance over understanding. We even take pride in our ignorance.

Here are a couple of posts I have written on the topic.

2009’s Top Threat To Science In Medicine

Happy Equinox!

Here is a link to an article reviewing a lot of research on the subject

lunar effects (full moon) The Skeptic's Dictionary - Skepdic

Then there is this amusing abstract, which points out the ridiculous nature of the belief in a full moon effect -

In this report, the established timing of terrestrial tidal gravity fluxes is examined to assess the role of the full moon per se in modern gravitational lunacy theory. The results show that the principal tidal gravity fluxes are semidiurnal, with lesser diurnal and even smaller fortnightly components. There are no uniquely monthly components that would correspond to the period of the full moon. This means that the gravitational effects of the new moon are equivalent to those of the full moon. Furthermore, the gravitational effects associated with the times of high tide are even greater than those associated with the moon phases. Using the technique of reductio ad absurdum, I suggest that lunacy effects, if indeed there are any, should occur twice each day (high tides) but should be more pronounced during the new moon and full moon (spring tides). On the basis of this analysis, I would recommend that all studies that have compared hospital records with the full moon be redone to coincide with the proper timing as found in this report.

Gravitational effects of the period of high tides and the new moon on lunacy.

Myers DE.

J Emerg Med. 1995 Jul-Aug;13(4):529-32. Review.

PMID: 7594375 [PubMed - indexed for MEDLINE]