Emergency Room Ruminations

Now and then I work in the Emergency Room.  The latest trend is to call it the “ED” for Emergency Department. (An unfortunate abbreviation, that makes me laugh). The logic is that gone are the days of my youth when it was really a room.  My earliest memories of the emergency room are not what most would imagine.  My father was a surgeon in rural Missouri.  This was a time before seatbelts.  We knew that when it rained, cars started smashing and the phone rang.  Then Dad went to work.  No pagers, no cell phones.  This was also a time before much medicine really existed; even antibiotics were limited in number. Medical care was still largely surgical care. Since we only had one car for our large family, we would go to the hospital with Dad sometimes, and we were greeted by rows of large staring eyes.  It was usually quiet.  My siblings hated going. People had driven many miles typically and at night no doctor was in the building.  Those folks had already heard the nurse talk to the doctor’s children, heard the pause as we ran to get him and then heard the nurse talk to the doctor.  Privacy wasn’t really needed, everyone knew everyone and everything, either before the visit or by the time they left.  People waited. We waited. Dad was done when he was done; there was no point in discussing the matter.

Yesterday my day in the Emergency Room was very different.  Where I worked is not a “trauma” center. So all the car wrecks go to “the big house”, the main University Hospital.  The reality is most people that would have been pulp in my youth walk away now.  Seatbelts and air bags continue to amaze me. So as an internist, I’m left with the walking wounded, my comfort zone.

 The sad reality is most of the illness I saw were related to smoking.  Not lung cancers mind you, but coughs, colds and pneumonia.  For me the saddest cases are the small children.  Not one child I saw with a fever lived in a house with non smokers.  Research supports the high number of illnesses adult smokers give their small children.  It only helps a little that the parent smokes outside. Smoke is on the clothes.  Even with my poor sense of smell, I can smell the smoke on the parent’s clothes.  It is always tempting to berate the parent.  How can they do this to their own child?  But I also know they are worried and hate to see their child ill, yelling never helps.  The children trust and love their parent.  My advice is gentle and persistent.  Tobacco is expensive; it makes their children sick; it makes them sick; it smells.  Smoking is a pediatric disease.  They are more likely to have smoking children because their loving children will want to be just like them. 

Things change.  The harsh reality is far more people die from smoking than from trauma now.  My Dad would be surprised.