the adrenaline rush that came with not knowing what would come through the doors next. Emergency medicine was often like a puzzle and he enjoyed the intellectual stimulation of figuring out where the pieces fit and what the picture was. He also enjoyed helping people, although these days the doctor-patient relationship had changed. Now it was all patient satisfaction scores and other metrics that appeared to have little to do with practicing good medicine. There were days when it was hard to stay in touch with the reasons he’d wanted to be a doctor in the first place.
Susan stuffed the towel into the bin. “Know what I love most? When someone comes in all bandaged up and you never know what you’re going to find when you unwrap it. Man, I love the suspense. Will it be a cut the size of a pinhead or will the finger fall off?”
“You’re ghoulish, Parker.”
“I am. Are you telling me you don’t like that part?”
“I like fixing people.” He glanced up as one of the interns walked into the room. “Problems?”
“Where do you want me to start? There are around sixty of them currently waiting, most of them drunk. We have a guy who fell off the table during his office party and hurt his back.”
Ethan frowned. “It’s not even December.”
“They celebrate early. I don’t think he needs an MRI but he’s consulted Dr. Search Engine and is insisting on having one and if I don’t arrange it he is going to sue me for every cent I’m worth. Do you think it would put him off if I tell him the size of my college loans?”
Susan waved a hand. “Ethan will handle it. He’s great at steering people toward the right decision. And if that doesn’t work he’s good at playing Bad Cop.”
Ethan raised an eyebrow. “Bad Cop? Seriously?”
“Hey, it’s a compliment. Not many patients get one past you.”
Backache, headache, toothache—all commonly appeared in the department, along with demands for prescription pain meds. Most of the experienced staff could sense when they were being played, but for less experienced staff it was a constant challenge to maintain the right balance between compassion and suspicion.
Still pondering the Bad Cop label, Ethan walked to the door but his progress toward the patient was interrupted by the arrival of another patient, this time a forty-year-old man who had suffered chest pains at work and a cardiac arrest in the ambulance. As a result, it was another thirty minutes before Ethan made it to the man with the back injury, by which time the atmosphere in the room was hostile.
“Finally!” The man stank of alcohol. “I’ve been waiting ages to see someone.”
Alcohol and fear. They saw plenty of both in the emergency room. It was a toxic mix.
Ethan checked the records. “It says here that you were seen within ten minutes of arriving in the department, Mr. Rice.”
“By a nurse. That doesn’t count. And then by an intern, and he knew less than I do.”
“The nurse who saw you is experienced.”
“You’re the one in charge so it’s you I want, but you took your sweet time.”
“We had an emergency, Mr. Rice.”
“You’re saying I’m not an emergency? I was here first! What makes him more important than me?”
The fact that he’d been clinically dead on arrival?
“How can I help you, Mr. Rice?” He kept it calm, always calm, knowing that in an already tense environment a situation could escalate with supersonic speed. The one thing they didn’t need in the department was a bigger dose of tension.
“I want a fucking MRI,” the man slurred. “And I want it now, not in ten years’ time. Do it, or I’ll sue you.”
It was an all-too-familiar scenario. Patients who had looked up their symptoms on the internet and were convinced they knew not only the diagnosis but every investigation that should be performed. There was nothing worse than an amateur who thought he was an expert.
And the threats and the abuse were just two of the reasons emergency room staff had a high burnout rate. You had to learn to handle it, or it would wear you down like the ocean wore away at rocks until they crumbled.
In the crazy period between Thanksgiving and Christmas, it was only going to get worse.
Anyone who thought it was the season of goodwill, should have spent a day working with Ethan. His head was throbbing.
If he’d been one of his patients, he would have demanded a CAT scan.
“Dr. Black?” One of the residents hovered in the doorway and Ethan gave him a quick nod, indicating he’d be there as soon as he could.
As attending physician, everyone looked to him for answers. Residents, interns, ancillary staff, nurses, pharmacists, patients. He was expected to know it all.
Right now all he knew was that he wanted to get home. It had been a long, miserable shift and that didn’t seem likely to change anytime soon.
He examined the man thoroughly and explained calmly and clearly why an MRI wasn’t necessary.
That went down as well as he’d thought it would.
Some doctors ran the tests because at least then the patient left happy. Ethan refused to do that.
As he listened to a tirade describing him as inhuman, incompetent and a disgrace to the medical profession, he switched off. Switching off his emotions was the easy part for him now. Switching them back on again—well, that was more of a challenge, a fact borne out by his disastrous relationship record.
He let the abuse flow over him, but didn’t budge in his decision. He’d decided a long time before that he wasn’t going to let his decision-making be ruled by bullying or patient satisfaction scores. He did what was best for his patients, and that didn’t include subjecting them to unnecessary testing or drugs that would have no impact or, worse, a negative impact on their condition.
“Dr. Black?” Tony Roberts, one of the most senior pediatricians in the hospital, was standing in the doorway. “I need your help urgently.”
Ethan issued instructions to the resident caring for the patient and excused himself.
“What’s the problem, Tony? You have an emergency?”
“I do.” Tony looked serious. “Tell me, do you believe in Santa Claus?”
“Excuse me?” Ethan gave him an incredulous look and then laughed. “If Santa existed, he’d probably threaten me for pointing out that not only should he lose a few pounds for the good of his health, but that if he intends to ride in a horse-drawn vehicle at an altitude in excess of thirty thousand feet he should probably be wearing a safety helmet. Or at least leathers.”
“Santa in leather? Mmm, me likey,” Susan murmured as she passed on her way to speak to the triage nurse.
Tony grinned. “Just the cynical answer I expected from you, Black, which
