It’s 2am, the dead of winter, and sure it’s not 10 below or anything but still it’s cold and drizzly and most reasonable people are content to stay at home cozy in their beds.  Then again, my patients tend to not be reasonable.

I unenthusiastically pull the chart from the to-be-seen rack.  I should be more eager, or appreciative, I mean I’m tethered to the ER anyway and my paycheck will be zeros unless I have patients to see so I might as well put my time to good use.  Still, cold hard logic is no match for my inherent laziness and desire to be left to my own devices.

The triage note says “18 month old with vomiting x 2, MMM (moist mucous membranes), taking pedialyte without difficulty”  – medical code for “inappropriate ER visit.”  The rest of the chart continues to build a case for a “not sick” kid: no fever, no medical problems, six prior visits all for minor stuff.

I size up the little dood and two seconds later decide I’ll be sending him home.  I then go through the motions: get some details from mom so I’ll have something to chart, a perfunctory exam, offer some reassurance and things to look out for.  I write for 2 of zofran since it treats both mom and kid and once again the chart goes ka-clonk but this time more satisfyingly in the discharge rack.

In the meantime someone else has checked in.  ”42 year old female, burning with urination.”  No fever, normal heart rate.  Her urine was sent to lab out of triage and I’ll wait for the results before seeing her.  

There’s some static from the EMS radio.  The nurses groan audibly and why not — they’re salaried and therefore have no motivation for the ER to be anything other than slow.  Medic 3 is bringing in an inebriated 22 year old whose friends are concerned he has “alcohol poisoning” whatever that is.  I’m always amazed by the number of drunk college kids who find their way to the ER — calling 911 would never have even occurred to me when I was in college — but he’s on his way in so no sense dwelling on it.  A quick assessment confirms he’s smashed so he gets IV fluids and some time to sober up.

The urine comes back so I double click on the lab icon to get the results.  I’m excited to see she has a urinary tract infection — no more figuring out what’s wrong, instead I’ve made another dispo and can send her home.  I update her on the results, not that I’m telling her anything she doesn’t already know.  She gets a prescription for the antibiotics she came for and out the door she goes with a resounding ka-clonk.

I sit down and excitedly prepare to do nothing, but two more charts ka-clonk the rack: “worried about bird flu” and “sneezing.”  I keep plugging away.