She parks her wheelchair in the hallway, glowering at the nurses. We're all watching the board; new 'red' (needs to be seen') in 13, and the chief complaint is a post-op leg infection, started bothering her today, normal vital signs. We try and see everyone within ten or fifteen minutes of coming back, and sick ones of course right away. By the time I get in there, Mrs. not sick and her husband are irate. Why did they have to come to the ED? Can I call Mr. Bones and have him come in and see her personally to avoid the wait? No, you have to see the resident. Well, what's taking them so long?
The ortho resident that night was awesome. We gave her sandwiches out of the patient fridge, she was doing so much. I had first-attempted a reduction of a complicated ankle fracture dislocation that literally had no solid structure connecting the leg to the foot, and that was one of four of her cases currently in the department.
I'm sorry for your inconvenience, ma'am, but we have to see people here based on how sick they are and I know of at least four other serious fractures right now.
Still didn't work; they backed off but passively kept trying to see how they could jump the line.
Last night, a guy came in with decreased sensation to bowel movements, buttock numbness, thigh numbness, and new erectile dysfunction. He got an MRI for possible early cauda equina syndrome. His question? How long will this take? I can always come back. I was like, dood, you're getting a stat MRI. Do you know how hard that is to do?
Also affluent, he had been told to get an MRI by his golfing buddy who was, you guessed it, a doctor.
I don't disagree with the call, I advocated it. He did have anesthesia and decreased rectal tone (although, ahem, there were 'other' reasons for that in retrospect and on full social history), and the new ED was alarming. But his status led him to expect certain things. Quick emergent service by the best, and full answers, and the best scans.
Over at M.D.O.D., God love them, they discuss the entitlement of the freeloaders. I'm as scared of the entitlement of the upper classes.