A Day in the Life of an Emergency Department Doctor
- August 12, 2022
Overdoses, COVID-19, Coffee and Costume Making
Name: Dr. Val Vigil
Job Title: Emergency Medicine Physician
Education and experience:
- Bachelor of Science, New Mexico State University
- Worked at the Grand Canyon for one year as a wildlife biologist before medical school.
- Medical school at the University of Iowa
- Internship at the University of Wisconsin in Madison
- General Surgery at Maricopa Medical Center in Phoenix, Arizona
- Emergency Medicine residency at Stanford University
What led me to my current role:
As a teenager, I loved helping my father (family practice physician) on medical missions. Although I explored several possible careers in college, all eventually led back to medicine. It has always been my true passion. Emergency medicine was my best fit in almost every way: fast-paced, ever-changing, and with such an opportunity to make an immediate difference in someone’s life. It’s also a plus to go to work surrounded by such amazing people!
Up with the alarm after hitting snooze twice. Long night, as the family all has poison oak on their faces and hands after a recent camping trip.
Leave notes about each one’s medicine, reminders for school, and a “love you” Post-it on the floor. Quick shower and 2 cups of coffee, and out the door.
45-minute drive to work, listening to medical journals. And 15 minutes of my favorite audiobook. Who doesn’t love Stephen King? 🙂
I realize I have passed Starbucks and have not picked up my mobile order. Huge sigh. This is twice in one week, too much money to waste! I quickly make a U-turn and race for the caffeine. I see one of our regular homeless patients who uses a wheelchair at the store and quickly check in with him.
Arrival at work! 20 patients are here with one doctor working efficiently. In-depth discussion of all the patients ensues, and we tag team to help the patients as fast as we can. The first few ambulances of the day roll in: chest pain.
Did you know the most common time of day for heart attacks is in the morning?
A quick call to my 15-year-old to make sure he’s up and at ’em, has had some type of breakfast, remembered his medication for the poison oak all over his face and remind him to catch his bus to school! He’s tired and grumpy. Poor kid.
Made a call to the babysitter to remind her that my youngest child has gymnastics today and to see if she can find some clean gymnastics clothes for her. Speak to my sunshiny 7-year-old, who always makes me laugh!
8 patients have checked in within an hour.
A person struck by a motor vehicle comes in as a trauma. Trauma patients need urgent care and require a lot of resources. No time for donuts as there is too much happening.
I’m wondering why my stomach is aching, but then remembered that I have not eaten. Oops! Third cup of coffee going in! I will have to try for lunch instead.
We continue seeing new patients, and I am struggling with being able to discharge multiple patients safely. I realize that we have given away all of our substance-abuse resource sheets (which we had more than 100 copies of less than a week ago), and I sigh. I wish we had more drug and alcohol addiction resources. As I discharge another underage patient after a severe drug overdose, I wonder if parents truly understand what resources are available to their children in school these days?
Taking a few minutes of fresh air outside the hospital in the beautiful sun. It’s healthy to get out of your mask every once in a while. Then I realize I haven’t used the restroom since 6 AM, and I cringe. Sometimes bringing the mentality of a mother/ nurturer onto these shifts makes me a great patient advocate…but a terrible self-advocate. I should work on that. *sigh*.
As I’m on my way to the cafeteria to get some food before they close, nurses call out while wheeling a young man who appears to be having a really hard time breathing. He’s not fully vaccinated for COVID but luckily, his COVID test is negative. He does tell us he uses “heroin, sometimes oxy, sometimes M30s,” and that he recently had some vomiting in his sleep. Sure enough, the chest x-ray shows that his right lung is entirely filled with what I assume is vomit/infection. He’s on the highest level of oxygen that we can provide for him while awake, and he looks tenuous. I have told him that, unfortunately, the next step is a breathing tube. He looks scared.
I see several other patients. One is a charming elderly woman who fell and suffered a hip fracture and a pelvis fracture. Another is a woman with a severe headache and a new brain tumor.
I sneak in a call to my childcare helper to remind her that the youngest child has gymnastics and see if she can help us wash the dog?
I see a young lady with high blood sugar and vomiting that won’t stop. However, she feels much better after receiving IV fluids and medication to bring her blood sugar down. I discuss the absolute importance of watching what she eats and taking her medicines, explaining that if she does not, she may lose her feet, legs, and vision, have a heart attack or stroke, lose her kidneys, and end up on dialysis. I search her eyes for understanding, and I think I see it. Right? Or maybe I just hope I do. I need something positive to cling to today.
I just saw and sent home several patients with abdominal and chest pain with no apparent diagnoses. I explain that this is a good thing, that we do not see any heart attack or infection anywhere, bleeding or obvious mass or cancer — and that they need to follow up with their regular doctor. 4 of 5 tell me they cannot get in to see their regular doctor, and one does not have a doctor and says no one new will take her as a patient. Ugh, so stressful. I feel a responsibility for these patients. I cross my fingers and call for a social worker/case management.
Hallelujah! My absolute favorite case manager is here, and some days she really keeps the world running here at Natividad in the emergency department. She will help me with calling for follow-up on these patients. I realize we have 2 homeless patients who are sick with no place to go. This is also going to be a real doozy. Case management nurse to the rescue again. I owe this woman a favor and a Starbucks gift card 🙂
My shift is nearing an end, and I see paramedics and firefighters rushing in a young man on a breathing mask. I have a horrible feeling when I realize it’s a young man with a drug overdose who was just discharged only hours ago — even after extensive counseling about drug use — and a discussion of all the free resources that are available to him. By the report, he went home and must have taken additional fentanyl/oxy (oxycodone) and possibly other drugs such as Xanax — and was found down on the floor, hardly breathing. This time he looks worse than last time. This time he will need a breathing tube and may not recover. One of my partners nods at me and says, “Go home. I’ll get this.” And she does. What a wonderful thing to be surrounded by such great staff.
As I note I am 60 minutes late leaving (which is pretty good for me), I spy 2 of my patients who still appear uncomfortable, with no discharge papers in their hands. I go back in and check with the nurse. Turns out we didn’t have the medication I initially ordered, and the second patient needs a referral to a specialist. I sit back down at the computer, get these things done, and then check in with the nurses before leaving. This time, they say all is clear!
Another 2 ambulances pull up to the hospital as I am leaving. I take a deep breath and remind myself that my shift is over and there are great doctors and PAs on shift that will help these patients. Breathe in for 3 seconds and out for 4. After a few of those repetitions, I feel much calmer. Or maybe it’s just slightly lightheaded? 🙂
Wiggle in a quick shop at Safeway, then head home. Intermittently checking emails as I am in the grocery store since this is the most alone time I will get today.
I get home and enlist my 15-year-old son and 6-year-old daughter to help me cook dinner, pack lunches for the next day, and finish chores. I remind them that if they always roll their eyes at my requests, they might get stuck that way.
My husband (also just home from working in the ER in San Jose) is tending to 1 of our 3 elderly dogs, and someone has vomited in the house. Unfortunately, I can’t find more 409/bleach cleaner, so I quickly order some on my phone while making the soup.
In the middle of dinner (finally), my daughter reminds us she needs a costume for tomorrow’s school theme — it’s hard not to give up and lie on the couch at this point. So we brainstorm and come up with a costume idea.
After dinner clean up (how are there always so many dishes?), giving the dogs their medicine, feeding the turtle and putting the chickens in their coop for the night, we start on the school costume.
After a few mishaps with the hot glue gun and lots of rummaging, we come up with a completed outfit. This leaves us 45 minutes of time to watch a family show, “Hawkeye” — we are big Marvel fans — check a few pieces of mail and arrange an Amazon return for the next day.
Sleep! Until tomorrow…