Week Three: Babysitting in the ER: How did I get here?

On Tuesday afternoon, I stood in the hallway of ER Bay C discussing octopus stickers with an 8-year-old girl, trying to keep both of us out of the way of passing beds containing patients returning from surgery and imaging. So how did I end up babysitting in this hectic environment? One of the Emergency Room (ER) doctors was nice enough to let me shadow her on this day. When a young mother required a vaginal exam for severe pain and swelling caused by her IUD, she was hesitant to leave her kids but also hesitant to have them in the room. I thought: “This is my chance to do something helpful rather than just being a fly on the wall!” So, I stepped up and offered to stay with her two kids instead of going into the exam room.

The ER is a busy and crowded place with 2 beds per small room and beds lining the hallways, but most of these people are not in immediate danger. When people first come into the hospital they go through triage, either through the walk-in door or the ambulance bay and then they are sorted between three ER sections, mostly by random. Most of the patients I saw were experiencing pain in their abdomen or back or had bad flu like symptoms. I learned a few things during my time there: 1) There is a well-organized method to the madness 2) Most people in the ER are not dying 3) ER shows really must go looking for the drama to make it interesting 4) All hospital personal, especially those in ER, deserve the utmost respect for their effort and patience 5) I am not sure what to talk to kids about after we after we have named every animal sticker in the book.  

While I was in the ER, I took some time to talk to the Point of Care Technician. Point of care diagnostics is my area of research for my PhD back in Ithaca. Point of care means something that can be used anywhere, especially at a patient’s bedside or in developing countries. Typically, these devices work very fast and do not require a full-scale laboratory but may not be as accurate as typical testing. There are many of these devices on the market and in development, but this ER largely only used devices for blood nutrients (Figure 1), troponin for heart function, a blood clotting panel, a UTI detector, and a rapid pregnancy test. The largest gap in the ER and in the various ICUs seems to be diagnosing infectious disease. A positive diagnosis usually only comes from direct identification of a pathogen in a sample from a patient, which can take days if not weeks of culturing and testing. I am more motivated than ever to continue my work back home in point of care diagnostics for infectious diseases.

Figure 1. Alere EPOC Blood Analysis system used in the New York Presbyterian ER to measure pH, carbon dioxide, oxygen, sodium, calcium, potassium, glucose, lactate, and creatine in less than 3 min

I also had the opportunity to sit in on a patient visit for the Research in Old Adults with HIV (ROAH) project. The first part of the study involves the volunteer filling out a questionnaire for about an hour, but I had the chance to read the questionnaire and it got me thinking about how much work goes into designing a clinical research study like this. The phrasing of the question can influence the volunteer’s responses which is especially problematic when the questions are asking about emotions, as this one was. I look forward to getting the data from the clinic trial soon, so I can start analyzing it to see if what interesting correlations appear.

The rain kept me largely inside this week, but I have enjoyed walking on nice evenings. From the roof of my building I saw a lovely New York sunset between buildings (Figure 2). I look forward to attending a Broadway show soon. This weekend, I intend to lay in Central Park with a nice book I got from the library.

Figure 2. New York City sunset from the rooftop

Figure 3. Look Mom! New Coat! 

Bonus Facts:

•         Up to 1/4 of the worldwide population has latent or active Tuberculosis.
•         Tuberculosis is the leading cause of death in HIV patients.
•         Patients with tuberculosis and other infectious disease are kept in negative pressure rooms which suck air in, so the infectious agent doesn’t spread into the hallway.
•        Patients lacking an immune system may be kept in positive pressure rooms which only blow air out of their room, so that infectious agents don’t get into their room.
•         One HIV positive patient can have many different strains of the HIV virus in their system at any time.
•         Only one person, the Berlin Patient, has ever been cured of HIV. It was a happy accident and doctors and scientist haven’t been able to repeat the results, yet.