One Stop Shop | Straight Talk from the Stanford ER

One Stop Shop

I went into emergency medicine because I wanted to be able to help any person and do it anywhere. The field offered a body of knowledge I could use to help any patient that might enter the emergency department. Of course, it did not take long to realize how much my ED care relied upon other specialists, nurses, medical devices, and the vast resources of the hospital. In a neighboring blog Paul Auerbach describes medicine with far less resources as he has been doing for years in wilderness medicine. For me, I come closest to my initial goals of broad and independent care on the basketball court and through the questions posed by friends and family. It is those questions from family that are the most difficult and perplexing.

Largely because of the type of injuries pictured above my current gym bag now contains tape, splints, ice bags, hot packs, and bandages. The picture is my pinky after a jump shot gone wrong. I remember looking down and seeing my pinky pointing to left while my other fingers pointed straight ahead. Without thinking my normal hand reached out and straightened the finger while I gasped in disbelief. Luckily, the normal hand made the right decision by reducing the dislocation. It hurt, but at least the pain was somewhat mitigated by fulfilling my life's ambition, providing immediate medical care, and buddy taping my little finger to my ring finger.

Injuries as shown in the picture to the left require a higher level of care but one that I am still able to independently address. In this case, a rebound gone wrong, my eyebrow was split open by one of my ED attendings. It is for this reason that I have lidocaine, sutures, and a sterile laceration kit in my house. The truth is that I still needed some assistance to repair my orbit but the laceration kit is ready for a more accessible wound.

By far the most difficult cases I have ever encountered have been those posed by my immediate family. Surely, they think that I should be able to solve any medical problem they encounter. Unfortunately, the solvable problems such as a laceration, fracture, or pneumonia go directly to the ED and unanswerable questions are left for me.

For instance, my sister's boyfriend is 38, and two days ago noticed this bruise on his back. He has an improving pain located at the midline of his lower back and this rash, which has happened 5 times in the past in a similar distribution. He did not experience any trauma, and did not have any prior medical problems or associated symptoms.

Once I ruled out alien abduction I did not think he was in danger but I did not know the origin of his bruise. Since he was not going to seek further care based on my telephone estimation of his condition, I did feel obliged to verify that he was safe to heal on his own without a clear answer. To make sure I polled my dermatology colleagues who probably could post a similar blog about such alternate channel medical questions. The dermatologists did not have a confident explanation but believe that he was safe.

So far residency has given me some of the tools I hoped to obtain but it has also shown me that helping people is more complex than I originally believed.

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About the Author

The Stanford Emergency Room is the center of emergency care at Stanford University.