FEATURE
CAN YOU DO MORE with Less?
Zach Harris, MD
A
t 0645 in the morning, the cavalry
arrives. They are courteous; they smile
with as much sincerity as can be mus-
tered at such an unreasonable hour, and ask,
“How was your night?”
My mind replays the night with some
lingering unrest. There were 20 patients in
the waiting room when I arrived, with four
roomed and waiting to be seen. We were down a nurse and a tech
in our ER from staff call-ins and the charge nurse was frantically,
admirably, attempting to fill the gaps, knowing more losses of staff
were to come at 2300 and 0300.
I replayed my patients from last night, a steady night with 34
in total. Some patients stuck out, the middle-aged man with the
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LOUISVILLE MEDICINE
inferior MI who was talking on arrival, and 20 minutes later, I had
intubated and shocked him eight times after his heart decided it
was angry about the clot in his stent. His family was kind. I was
glad to see Cardiology save that man’s life. I thought of the cancer
patient upstairs on the ward, who had arrested, and how hard it is to
terminate even futile care sometimes. I thought about how difficult
it can be to hold delicate discussions of tragedy over the phone with
the loved ones, and how sacred and precious and fragile our lives are.
Covering a >300 bed hospital for codes and procedures, in
addition to a busy ER, at night with single coverage (no other doc)
is a great teacher of humility. But not all cases were heavy; my
thoughts turned back to the 90-year-old I pretended to dance with
as I helped her show me how well she could walk (unsteadiness in
some can be a life threat that doesn’t have an elevated troponin or
lactic acid). Seeing the joy our exchange gave her recovered the