hotel california - my trip to the ED

Yesterday I had to admit myself into the emergency room after doing a "dumb thing" -- I slipped and fell breaking a picture frame and the shattered glass made a cut in my right forearm. The cut didn't look that serious and I didn't even plan to make a trip to the hospital. My mom had a different agenda. After running water over the cut and covering it with an alcohol soaked paper towel, I was dropped off in front of the emergency department.

It took about an hour before I was brought to triage and escorted to a room in the Acute Green section of the ED. It felt silly to be put into a private room and a bed for a little cut, but the nurse joked that it was all "included in the price of your stay today".

The first person to see my was an MD/PhD student who took a basic history before presenting my case to the resident. I asked the medical student "What year are you in?" and he replied "It's my ninth year". His PhD had taken him 7 years, and he was back in medical school to complete his last two years of clinicals. I was amazed by his dedication to medicine and science, because I don't know if I'd have enough passion to spend this much time in school 🥴

When the resident came in to see me, she inspected the laceration or the cut and told me the attending physician wanted to do an X-ray to make sure there wasn't any glass before sewing me up. I was honestly a little annoyed about this, I just wanted them to stitch up the cut so I could go home and study. I thought it was an unnecessary measure because I had already thoroughly rinsed the lac with water and by the looks of it, there was no glass.

A sweet transportation technician came to my room a while later and wheeled me into the radiology room. I was really uncomfortable being pushed in a bed when I had no trouble walking, especially when I was surrounded by people who clearly needed this kind of service much more so than I did. The lab technicians took two views of my arms before I was wheeled back to my room.

In school when we order imaging or labs for case based learning purposes, we get them almost immediately. That immediate gratification is so far from reality. I waited another hour or so before the resident and the medical student came back to tell me that they had found a shard of glass on my xray.

The glass was a little over half a centimeter, which considering my cut was only a little bigger than 1 cm, was quite large. The resident came back with the medical student and the attending physician to explain the situation to me, and they decided that it would be best to use ultrasound to locate the glass piece before they went digging. They found it a little less than a centimeter from my initial cut and about 1 cm deep. The attending physician expressed her concern about the surrounding vasculature and nerves and explained that she felt she could not do this extraction without risking permanent damage.

At this I finally recognized the severity of the situation. The attending was making calls to trauma and orthopedic surgeons because the foreign object was in a place that she felt only specialists could handle. All this trouble because of a clumsy fall.

The next 2 hours while waiting for orthopedics were pretty scary. I tried listening to audiobooks, doing anki cards, talking to friends, but nothing could shake the thought that regardless of how skilled this orthopedic surgeon was, there was still as risk I'd lose some motor or sensation in my forearm. A surgeon I knew who worked at the hospital gave me a call to explain what to expect. Even though he gave me worst case scenario -- sedation and making a new incision in an operating room -- I was still not at ease. It didn't help that I was alone the entire time either.

When the orthopedics resident finally came he told me he'd be operating bedside, and that it was a simple foreign object removal. This was WAY less serious than the other physicians had told me made it out to be.

He brought some consent forms for me to sign and began setting up a sterile field to begin the operation. I asked before we started "Do you know where it is?", and he said he looked at my film and that he did.

He injected lidocaine around the cut to numb the pain before he began using tweezers and forceps to extract the shard. 10 minutes later, he still did not find it. He took his gloves off and told me he needed to look at the film once more. When he came back another 10 minutes later, he tried again with no luck.

"I think we should just leave it in"

This was his next comment, reassuring me that it would not cause me any major problems and preparing to suture me up. I was not comfortable knowing there was a foreign object still in my arm!! I put on my most convincing pleading face and asked if he could get the ultrasound machine and try to locate the shard again, and extract it. Although initially reluctant, giving me excuses such as "My department isn't authorized to use ultrasound" or "The ER doesn't have those machines lying around", he found a machine and tried once more. It took a really long time to find the glass -- he switched ultrasound probes about 4 times before he was able to find it and extract.

We were both ecstatic, I was thanking him profusely for finding it and taking a huge weight off my shoulder, and he thanked me for not letting him give up. He sutured me up, a total of 5 stitches, and wrapped me up. The ED resident came to check on me afterward and I was discharged soon after. Only after I had left the hospital did I realized both the ED resident and the ortho resident had forgotten to prescribe me antibiotics. 😨 I returned to the ED, and looked for the resident that had taken care of me earlier. Unfortunately she had left and another doctor on call sent my prescription to the pharmacy. After a major delay at the pharmacy I finally got my cephalexin and headed home. It had been an 11 hour day in and out of the ER and pharmacies.

Although I wouldn't say I had the best luck through the ER, there are a few things I think are worth noting.

The patient's attitude in one way or another has an effect on the healthcare professional. I can imagine that if I had been rude and demanding, the ortho resident would have felt uncomfortable and pressured, making his already difficult job even harder. From medical students to residents to attendings, we are all human beings learning from experience and patients every single day. I can only hope the patients I see in the future can also be understanding and forgiving of me as I learn from them.

Doctors are bound to make mistakes, or make bad calls, but YOU are your greatest health advocate. If I had not spoken up insisting that I wanted the glass removal or had not run back into the ED to get my antibiotics I might have gone home shard in arm with an infection just waiting to happen.

Lastly, I appreciated this crazy experience because I used it as a mirror to introspect. To mimic the great qualities in the health care professionals I had seen, and to make sure I am always being thorough, following through with patients from admission to discharge. It was eye opening to see health care through the eyes of a patient. The sitting around and waiting differs drastically from the fast paced life doctors lead.

My trip to the ER can be summed up with an Eagles song, Hotel California