A mostashfa el-Basheer moment

The emergency room is a fun place to be. Sometimes it's crazy and pakced with sick patients and at other times it would be empty and you'll find nurses sitting down chatting and making fun of doctors.

Yesterday was one of those crappy busy days and the ER was so packed that patients, laying on beds, were placed in the hallways outside rooms. The patients thrown in the hallway were more than those inside the rooms. .

I was called to admit a lady (I'll call her Dickens) with a hand infection. She had some psychiatric issues (i.e. she was crazy) and she tried to kill herself once so she cut herself and her hand kept getting infected since then. Her dcotor in the clinic thought that she needed to stay in the hospital. He called me at 2 pm to admit her to the hospital. There were no beds and she had to stay in the hospital.

At 5 pm the clinic closed, so they had no option but to send to the emergency room until they find a bed for her in the hospital.

I went to the ER and she was standing in the hallway waiting for someone to place her in a room or a bed or a chair and leave her there, but there was absolutely no palce for her. I asked her to wait in the lobby but there were no places. She did not require urgent treatment and all patients inside the ER were really sick so it was not reasonable to kick them out.

I went to a nurse and asked him, "Can you place Mrs. Dickens somewhere in the ER? "

"Doc it's full as you see, send her to the lobby"
"the lobby's full"
"I dunno doc I dunno I have a patient with a BP of 40 I gotta go, maybe we'll have a place for her in the hallway in half an hour"

I went back to the lady, "Hey Mrs. Dickens do you wanna wait in your car for half an hour then come back here, maybe we'll find a spot for you."

"I don't have a car, I came by bus"

I felt helpless and started to understand why Arizona scored an "F" in the emergency room care grading last year. Every winter we have hundreds of thousands of people called "snow birds" come in from the cold states because winter is beautiful here. Most of them are old so they get sick and come to the hospital.

I looked around and the area OUTSIDE the hospital was even packed with people and their families. Oh my God, where the hell should I send this lady? My patient got very angry and unpleasant and said that she would leave the hospital against medical advice if we don't find a place for her. I couldn't blame her.

It was about 8 pm then, I went to the coffee machine and looked outside and found an empty zone.....

I went back to the ER where she was standing and shaking with rage.
"Hey Mrs. Dickens, I have a suggestion"

She looked at me

Then I paused, and I had one of the biggest internal conflicts in my life. I wasn't sure if I should say it or not, but I found myself suggesting, "Why don't you go out there near the coffee machine, there's a smoking area where you can have a cigarette, take your time and when you come back maybne we'll have a spot for you"
"Sure", she walked oputside and I went back to my computer and started writing orders. She became back two hours later (probably smoked the whole pack) but we had a bed for her.

Before she went upstairs I wanted to feel better.... "You know, smoking is bad for you"

"Yeah..... "

I cleared my conscience completely when I convinced myself that this lady who had four previous suicidal attempts would probably kill herself before smoking kills her.

Also , that day, I realized why they had a smoking area just outside the hospital!