Bug Bites and Paragliders

There are 2 young docs in the ER that perpetually seem flustered. When it is busy, they spend more time grumbling then working. They sit in front of the computer and shuffle through the patients they have yet to see, like they are shuffling their poker hand around to see if they can make a straight out of nothing. The hand they were dealt was a full house, but that is a losing hand unless you can empty it.

I show up at noon yesterday and start picking up patients. Young Doc is rushing about tending to a new CVA and a hypotensive patient with positve FAST exam. She says in a slightly condescending manner, "I'll see the sick patients and when I'm done you can tell me about bug bites." I skip the bug bites in room 13, and go straight for the diarrhea in room 9 as a subtle stand against PA pigeon holing. I figured the diarrhea had a bigger, albeit stickier, work up and a more complicated differential, so when young doc was done saving lives she could see the bug bites.

The only lesson from the diarrhea experience was one I have known for years: avoid the Jack in the Box chain. Something is just not right with that place.

Later in the evening, with the Young Doc phasing out and the Old Doc taking command, we found a rhythm in the busy hive that is the ER. Old Doc understands that I my job here is not to see just "Fast Track" patients and support the doctors as they see the "criticals". If they want to hire a PA to do that, fine. As a student, we see whoever. Including Paragliding accidents.

57 yo handle bar mustachioed paraglider stalled 15 feet above his landing and dropped flat on his back onto rocks, with a bounce. +Loss of conciousness, complaining of back pain, epistaxis. Attributes the fact that he doesn't know the month, date, or what he had for breakfast to "I'm and Artist." Friends dragged him off the beach and drove him to the ER. Actually, If they had called 911, there would have been other people in the room besides me and the nurse. But they didn't and I was in charge.

CT head, c-spine, t-spine, chest x-ray.....long story short he had a burst fracture of T4, which was a fortunate diagnosis for the mechanism of injury. He walked out with a boatload of pain meds (and stool softeners).

I have no problem seeing the simple stuff. It feels good, in fact, to bounce from room to room and feel like you have a grasp on what is going on. But because I am paying to work here, not vice versa, I'll take the liberty to see the bug bites and the paragliders.

BONUS QUIZ: What medication did I prescribe for the paraglider that will be administered intra-nasally? First person to comment with the right answer wins a prize!