A Normal Day

“The trouble with normal is it always gets worse.”

-Bruce Cockburn 

I'm officially done with my first rotation, and every shift has been just as crazy and hectic as the first one.  I'm not sure if it has really gotten any easier.  Sometimes it seems like the only difference is that now I'm a little better mentally prepared for the organized chaos I encounter every time I go through the revolving door into the ED waiting room.  Several people have told me that this is not what the ED is normally like, but I already know better than to believe that.  It's like when a doctor tells a patient that this won't hurt, right before stabbing them with a syringe of lidocaine.  Of course it hurts, at least until the numbing effect of the lidocaine kicks in.

When I press people to explain what the normal ED shift is like, I can't really get a good answer except for something along the lines of, "not like this."  Presumably, normal means that there are fewer patients.  Not only that, but fewer patients with non-urgent complaints.  I can identify with wishing there were fewer patients.  There is just a feeling of desperation that I get every time I look at the growing list of patients in the triage area when I'm already stretched thin in too many directions as it is.  As for too few urgent patients, that doesn't seem like a problem to me at all.  I have already helped care for patients who were sick enough to be admitted directly to the intensive care unit (ICU), and also patients who were sick enough that they didn't make it to the ICU.  Spending every shift caring only for these high acuity patients would be more than I could cope with, at least right now.

So the main issue seems to be one of patient volume.  But what does it even mean to say that the ED volume is above normal, anyway?  It's not like the number of annual visits to the ED is a static number.  In fact, we know that the number of yearly ED visits in Massachusetts has continued to increase even though a state health care reform plan was enacted in 2006.  In other words, this increased volume isn't some kind of aberration.  It's now the new normal.