Saturday, July 4, 2009

Tale of the missing patient...

Rob is encouraging me to collect "Tales from the ER"... and felt that this one deserved to be told.

Recently, I had a lost patient. Columbia's ER, while one of the largest in NYC (second or third) is really not that big when it comes down to it. Four rectangular patient areas connected in a line with short hallways in-between.

I sent the patient to ER x-ray expecting him to be back in about 15 minutes. His admitting doctors show up and, no patient! I direct them to x-ray. No patient. Radiology claimed they had sent him back. His wife was standing at my area's nurses' station without her husband.

Radiology didn't have him (the patient was stretcher-bound). In fact, his stretcher was still in x-ray with no patient on it. Multiple loops through every area of the ER did not reveal my missing patient. Overhead announcing his name and asking him to return yielded nothing. The surgery residents admitting him were extremely kind in trying to help my search, however they had no idea what the patient looked like! It is triply hard to find a patient in an ER if you don't know what they look like without walking patient to patient and taking names. As a result I was running around the ER with a team of surgeons trailing after me for an hour.

It should be pointed out here that (said in a snooty voice), "doctors don't run." However, we do walk damn fast.

The search expanded into the main hospital hallways around the ER. Maybe my stretcher-bound patient had wandered out... somehow. Security was notified and everyone was radioed the patients description (he looked like 90% of the patients at Columbia).

Finally, when me and my entourage made our fifth run through the ER, the patient is miraculously sitting in his assigned slot, in a wheelchair, looking definitely worse for the wear. Where had he been? CT on the 6th floor of the main hospital! Someone had taken the wrong patient from x-ray OUT of the ER and across the street and up to the 6th floor. Who takes an emergency room patient out of the emergency room!?!?! (point #2: the ER has it's own CT scanner INSIDE the ER. There is no need to patients to go to main CT in the hospital.)

The lesson for budding young doctors out there? Tell your patient the plan! I had told my patient, in detail: "You're going to x-ray. When you come back, you are going to drink contrast liquid. 2 hours after that, you are going to get at CT scan." If I hadn't, he wouldn't have put up such a fight in the main hospital CT (apparently, he caused a bit of a scene). The patient himself knew that he was lost and got himself returned to the ER. I just ran (read: walked briskly) around like a chicken without a head trailing a team of Transplant surgeons.

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