Yet another objection to the ER is that the shifts are totally disorienting. When I was on nights, at least that was a reliable reversal of day and night. Here, my start time changes by a few hours every day, and now I can’t figure out what day it is. I spent the entire ten-minute drive home trying to figure out what day it will be tomorrow, and what day comes after that; as for how to use my free time for the next two days, I’m still trying to figure out exactly what time I do have.

Today all the crazy patients caught up with me, in return for having stayed away for the last week. The attending started ducking when he saw me coming, because he knew it was going to be some totally psychotic person whose story nevertheless stood a good chance of turning up a real medical problem, which would leave us trying to treat the person over his objections, and juggling between medicine and psychiatry to get him admitted. I got into my first real fight with a patient, standing there putting my foot down and repeating, “You could die within the next twelve hours if you don’t let us treat this,” and her yelling back at me. (The attending helpfully sidled past in the hallway, and pretended he didn’t hear us.) Usually I hate threatening people like that; but this time it was perfectly true, and the patient’s insane refusal to recognize her extreme risk was completely infuriating. I’m sure tomorrow she’ll turn up septic in somebody else’s ER, and they’ll wonder what on earth we were thinking of, not to treat her appropriately. Arghh.

In addition to the crazy folks, there was the usual allotment of very nice people with very bad diagnoses, and all the ER could do was stand there and shrug and say, You’ll have to come in to the hospital. Please sit and listen to the drunk criminal arguing with the police at the other end of the hall for several hours while we find a bed. That’s my basic objection to the ER: it has very few solutions for the really sick people, who are the ones I want to know about. I’m not into triage; I want to find a definitive answer.