Ever wonder what life is like while practicing emergency medicine in very beautiful, very coveted areas of the United States? I won't name towns or hospitals because the situations are highly reproducible from place to place and season to season. We'll just call it St. Resort Hospital. If you doubt me, call up your friends who work in such locales with the rich, the powerful, and the well-rested. Or with the sunburned, drunk, and tasteless. Vacation sites cross all demographics but in different ways. Consider these.
“Dr. Leap, I'm having chest pain. I have pretty bad heart disease, and I saw my cardiologist at the university last week. He said I probably need another stent because I'm having chest pain a lot more than normal. But my wife and I decided to drive here for the week. What should I do? My son is a heart surgeon at Mayo Clinic.” (It's two hours to the nearest interventional cardiologist. And, of course, your son is a heart surgeon!)
“Dr. Leap, my daughter has a laceration on her face. By the way, I'm a plastic surgeon myself! Full disclosure, I trained at Harvard, and I'm faculty at Duke! Can you tell me how you're going to close the wound?” (He stands close by during closure, asking questions, sniffing, and making subtle noises to guide technique.)
From administrator: “Dr. Leap, Mr. Whatzit is a very, very important donor to the hospital. It's critical that he get good care. Do you understand?” (You mean, unlike the bad care I give everyone else?)
“Dr. Leap, I live in Big City, USA. This morning, I went for a hike, and now I have red bumps on my legs. I've been on the Internet and contacted my physician at home. He said I should be very concerned about brown recluse spider bites and Lyme disease, and that you should give me a prescription for doxycycline. Oh, and I'm a pharmacist.” (In the South, we call them bug bites and go on about our business, remarkably free of antimicrobials. The patient is unimpressed with my colloquial knowledge of unspecified bug bites.)
“Dr. Leap, I passed out! My wife and I have been married for 50 years, and we decided to come to South-Town and ride bikes to lunch. After about six miles, I felt so dizzy, I just fell over! Oh, and I'm on Coumadin. And I have a defibrillator. I'm a cardiologist myself, and my electrophysiologist is at Cleveland Clinic and wants you to call.” (Heat index around 115 degrees, humidity 100%. What were you thinking?)
“Hey, doc, I don't know how the heck that happened, but I had a few beers and went out into the surf at night and stepped on that dang stingray. Yeah, I'm drunk. What about it!?” (BP 215/110 mm Hg, which is also his peak and trough alcohol level. Patient hasn't taken meds or seen a doctor since the Reagan administration.)
“Dr. Leap, it's the funniest thing. I mean, I'm in good shape. I row 10 miles a day and run every other. But I came up here for a wedding, and I can't breathe! I have a headache, and I'm coughing. My living? Oh, I'm a malpractice lawyer. But my sister is head of pulmonary medicine at Washington University. Can you call her? She has a few suggestions for you.” (Sea level to 10,000 feet in one day, and I'm happy to be told what to do by someone who isn't here and thinks I'm a hick.)
“Dr. Leap, I know you say I should be admitted, and you're right, I can barely walk with that broken ankle. But I have a camp to clean up and an elk tag to fill. And nobody to drive me back home in my camper. So I hope you aren't offended when I sign out and go back. Nothing personal. I'll come back if I have to.” (This one I get. It's an elk tag! Who can blame him? [A tag is an application to hunt big game, usually awarded through a drawing or lottery.])
“Dude, I passed out on the beach, and my skin is, like, on fire! You have to do something! Oh, and I left all my Oxycontin at home before we brought the RV down. Can you help me out? My doctor is on a mission trip in Asia or some nonsense.” (Footnote: 60% BSA covered in sunburn, with scattered blisters. Prednisone, yes. Oxycontin? Nope.)
From the Medical Staff office: “Dr. Leap, here is the summer call schedule. Nobody is on call because everybody is on vacation. Good luck.” (Footnote: Technically, I'm on call. For everything. At least in some locations.)
Honestly, nearly all vacationers are nice people trying to stay healthy and have fun. The same goes for physicians and administration. But poor planning, unrealistic expectations of local facilities, and carelessness take their toll.
So next time you're tempted by the scenery in that glorious ad, remember to wear your sunscreen, acclimate gradually, and remember that 80 percent of the manageable annual volume will probably be compressed into the three months that constitute the lazy, hazy, crazy days of summer at St. Resort Hospital in Vacationville, USA.
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