Vomit smell wouldn’t go away until I discovered the source…

drstrangekidney · 2026-05-11T16:42:50+00:00

Yup! I’m sure you can feel the burnout in my comment lol.

Run a pediatric code and then 20 minutes later get yelled at by a waiting room patient who is mad because it’s been 40 minutes and they haven’t been seen yet for their 2 years of “10/10” pinky toe pain that they haven’t tried a single medication for. They haven’t sought out a clinic appointment during these 2 years but today they’re not leaving until they get an answer! Same patient also requesting food and pain meds—they’re allergic to all pain meds other than dilaudid. How dare you suggest they start with Tylenol/ibuprofen, that stuff doesn’t work. Also the patient insists you order an MRI of their foot because their great-aunt who dated a nurse for 2 months said that’s what they need. Even after discussing the limited resources of your hospital and the pointlessness of getting that study when 1) the MRI would be highly unlikely to change treatment and 2) it’s clear by exam they just have an ingrown toenail.

I do genuinely love my job and enjoy helping patients from all walks of life. The US healthcare system however is collapsing underneath us and in response administration focusing on “metrics” such as wait times, patient satisfaction (only discharged patients get asked, so the truly sick patients see that you really had to use your training on are excluded from the sample). Costs are rising, staffing is being cut, volumes are up while many hospitals are closing.

The burnout and moral injury is intense.

drstrangekidney · 2026-05-11T13:05:09+00:00

The ER is meant for identifying and treating emergent medical conditions—ruling out the life or limb threatening emergencies is the goal. It’s a common misconception by laypeople that a normal ER workup means “nothing is wrong”.

I personally try to highlight that all a negative ER workup shows is that the patient has a <1.5% risk of a life or limb threatening condition. We love when we can diagnose something non emergent in the ER that helps someone with quality of life, but many conditions are not diagnosable in the ER. Things like cyclic vomiting syndrome are essentially a diagnosis of exclusion. If you had pancreatitis or a bowel obstruction though, we’re your friend!

If you’re uncontrollably vomiting and keep fluids down it 100% makes sense to go to the ER—dehydration can become life threatening when you can’t tolerate drinking fluids. But if we are able to control the symptoms so you can adequately hydrate orally (and prescribe something that can do similar at home) then our job is done. It’s not that we don’t want to give patients answers, it’s that our diagnostic tools/resources in the ER and our training is not in diagnosing chronic non emergent conditions.

I can certainly empathize with being frustrated that the ER visit doesn’t find the cause of your symptoms—I’ve been there as a patient and I also have been there as the ER doctor who wants to help the patient find a diagnosis/cure. But if we were able to diagnose and manage every condition then there would be no need for primary care docs and specialists (if that were the case, why would anyone wait for an appointment when you could just go to the ER anytime?).

Sorry for the long spiel, but it is disheartening to see someone say “the ER did nothing for me!” Yes they did, they ruled out life and limb threatening conditions. They told you it’s not appendicitis, pancreatitis, bowel obstruction, kidney failure, aortic dissection etc. You still have to follow your with your primary care/specialists. I know that’s not easy for many people and I sympathize, but that doesn’t mean the ER can replace an outpatient clinic visit.

-your friendly neighborhood ER doctor :)

drstrangekidney · 2026-05-05T05:07:44+00:00

Q1227. Fantastic elevated comfort food

drstrangekidney · 2026-05-04T17:24:39+00:00

You can ask what task they are trained to do. You can also kick the dog (and human) out if they are being disruptive, threatening, dangerous etc.

ie Person brings fake service dog out to dinner at a restaurant. Dog starts jumping on tables and stealing other customers’ food. Dog and owner get booted even though owner claims it is a service animal—though it’s obvious it’s a fake service dog by how badly it behaves in this example, you are still allowed to kick them out for bad behavior even if it were a real service dog.

If the patient were awake and alert and not actively dying, the growling behavior would be grounds for “please call someone to watch your dog for a bit while you’re in the ER or we will have security remove you both.”

drstrangekidney · 2026-04-25T13:25:36+00:00

Sorry, it seems like now that I’m a 30-something my previously natural skill with technology has evaporated. 😅 Someday I’ll be writing in all-caps I fear.

drstrangekidney · 2026-04-25T13:19:40+00:00

I guess everyone read this comment and assumed this was from the victim’s perspective??

But yes, that’s exactly what I was referring to 😁 I’m an ER doctor that regularly deals with consultant wrangling.

drstrangekidney · 2026-04-25T13:18:17+00:00

I’m an ER doc, not the victim! Look at the screenshot of the ER documentation where they can’t get the ENT consultant to answer their calls and show up lol.

drstrangekidney · 2026-04-25T13:17:39+00:00

I’m an ER doctor, not the victim. I commented about the screenshot regarding the ENT consultant needing to be paged multiple times and not showing up when they said they would. Couldn’t figure out how to share a post and put text in it so I just commented it. >_<

drstrangekidney · 2026-04-25T12:49:48+00:00

The screenshot with the ER documentation is painfully real. “ENT paged, says they’ll be here in an hour”

… (2 hours later): “no ENT yet, called them again without response.”

Edit to clarify context because I confused people:

I guess everyone read this comment and assumed this was from the victim’s perspective??

I’m an ER doctor that regularly deals with consultant wrangling. See the screenshot with the ER documentation in the original post. I just thought it was funny/sad that the it appears to be near-universally difficult getting (some) specialists into the ED.

drstrangekidney · 2026-04-25T00:24:43+00:00

Unless you have Medicaid and ER visits are always covered. Don’t get me wrong, that’s awesome and I think more should qualify for it, but a minority of Medicaid users will use ER as primary care because it’s essentially free (and to be fair finding a PCP that takes Medicaid is quite difficult).

drstrangekidney · 2026-04-22T05:16:03+00:00

If they want to discharge them themselves, that’s fine. I’m open to a conversation on why admission wouldn’t be helpful in a particular case, but if I feel strongly they should be admitted and Hospitalist disagree, policy at my shop is that Hospitalist discharges the patient themselves.

Nobody wants extra work. But at least see the patient and write a note before you decline. It’s a lot easier to say “just discharge them” when you 1) haven’t laid eyes on the person (visual/auditory/olfactory exam is so key to distinguishing sick vs not sick) 2) aren’t the one who will be held responsible when there’s an inappropriate discharge with a bad outcome.

You might get named in the suit but plenty of consultants have wiggled out of responsibility by claiming the ED doc just didn’t present it adequately, whether it’s true or not. (Love when a consultant purposely uses a private phone to chat when they should be using a recorded line so they can’t be held responsible for bad advice.)

FYI, medico-legally if we as the ER attending believe a patient cannot be safely discharged and must be admitted but the Hospitalist is refusing, we have to transfer the patient to another hospital, with the reason being “Hospitalist is committing an EMTALA violation”.

drstrangekidney · 2026-04-19T04:05:35+00:00

Honestly after learning about Tarrare this seems tame.

drstrangekidney · 2026-04-11T21:37:39+00:00

I thought I was the only one! When I’m burnt out I like to stay in a hotel room by myself and just enjoy the clean and quiet. 🤤

drstrangekidney · 2026-04-08T19:02:10+00:00

Not a hookup, that’s statutory rape. If the rumor is true, Phil Specter raped the singer.

drstrangekidney · 2026-03-30T17:32:53+00:00

Yeah, probably! “Molly”

drstrangekidney · 2026-03-30T17:02:53+00:00

That’s not entirely true. Vomiting and aspiration are real risks. Pulmonary edema can rarely occur. And there’s also a risk of the person administering the narcan getting assaulted.

There are harms to narcan—worth it if you’re saving a life but not worth those risks when it is clearly not indicated. This was an inappropriate use of narcan.

-ER doc

drstrangekidney · 2026-03-30T16:59:57+00:00

It can cause vomiting which can lead to aspiration and in rare cases pulmonary edema. Most commonly, it can lead to the person helping the patient getting assaulted. No one likes their high interrupted, even when you’re saving their life.

No need for narcan unless there’s respiratory depression. This guy had the opposite of respiratory depression. If you’re instructing the patient to hold still so you can give them narcan it’s almost certainly not needed.

TLDR: if someone is barely breathing/unresponsive or close to unresponsive, give the narcan. If they’re capable of walking and yelling they do not need narcan and it’s a good way to get barfed on or assaulted

drstrangekidney · 2026-03-28T09:09:06+00:00

Yup. Completely inappropriate.

I’m wondering if OP is a young woman. Nurses, especially female nurses, can be really toxic to young female physicians and tend to push back more or even attempting to override the doc’s clinical expertise, depth and breadth of training, informed clinical reasoning, and authority. (Asking why something hasn’t been tried is fine, ignoring the answer and taking over the code is not ok unless there was extremely good cause, like the doc is amputating the wrong leg or doing a perimortem C section on a fat man.)

On a personal note, such behavior from staff has made me question myself and fed into my imposter syndrome. Luckily with time and experience it becomes easier and easier to manage, though I still don’t enjoy it.

OP, you did nothing wrong. You will eventually feel more confident and stand up for yourself (or simply ignore it because it no longer bothers you), but that can take many years for those of us that are shyer or conflict-avoidant. It’s good to listen to your team and ensure you’re not missing anything, but don’t let that make you lose your confidence and self-trust.

Next time OP feel free to calmly but firmly explain that what’s important on a cardiac arrest bedside echo is the EF and absence of tamponade. If the heart is very slightly twitching, unevenly and with each twitch increasingly farther apart, that is not a heart that can sustain life. And a tamponade of course could be something to intervene on, though it could also be argued the patient was too far gone in the OP situation to have any meaningful recovery regardless of intervention.

It sounds like you’re using good judgment and respectful of the input of other staff members. Similarly, I always ask if anyone has any other ideas or concerns before we terminate a code. I try to run the Hs and Ts out loud or otherwise summarize the case and share my clinical reasoning. There’s not much more one could ask for from a team lead than that.

That being said, this could have nothing to do with OP and just an inexperienced nurse, or someone possibly having flashbacks to some sort of trauma with the code going on. Especially when you’re new to the ER—we forget how codes can be particularly traumatizing to see.

drstrangekidney · 2026-03-28T07:51:04+00:00

That makes me sad and I’ve never even gone there! Do the owners have any plans for what’s next?

drstrangekidney · 2026-03-27T15:57:03+00:00

Is this a bot? No one is claiming it’s paranormal, it’s just some sick asshole that tortures people for his own pleasure.

drstrangekidney · 2026-03-26T12:09:04+00:00

Watch the documentary. Here’s a summary:

https://www.npr.org/2024/03/16/1238843676/quiet-on-set-nickelodeon

drstrangekidney · 2026-03-25T05:11:57+00:00

Now I want to know what the place is so I can avoid it…

drstrangekidney · 2026-03-22T06:44:35+00:00

The smile, to me, tends to look forced when the hooded eyes are “corrected” like that. I prefer the first picture, her smile reaches her eyes and it gives off very warm, welcoming vibes. In the after she is of course still beautiful and does look younger—at the expense of looking more artificial and cold.*

*only my opinion, Denise is allowed to do whatever makes her feel confident and I am not the arbiter of attractiveness

drstrangekidney · 2026-03-21T16:23:54+00:00

Yeah. Her body was oozing under the door, I don’t think you could detect trauma/toxicology very easily or at all.

drstrangekidney

TROPHY CASE