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In Case of Emergency
When he puts on his teal scrubs, emergency room physician Dr. Richard Waddell becomes a different person — focused, decisive and approachable by patients and staff alike. Once he clocks in, he wastes little time. Sitting down at a computer at the far end of the nurses' station, he begins gathering pieces of the stories of patients he will treat today.
"I love the detective work," he explains while reviewing a patient's past lab work and prior admissions to the hospital.
"I feel like I am here to make things easier for people," he adds. Standing, he grabs a few blank pieces of note paper and a pen. "Let's get started."
In today's eight hour shift in Northwest Hospital's emergency room, Dr. Waddell will manage the care of 21 patients. He will assist on two other cases. Two of the patients will be critically ill and intubated, one suffering from pneumonia and the other from COPD. Of those 23 people, six will be admitted to the hospital and 17 will be discharged. Dr. Waddell will conduct evaluations for headaches, sore throats, an abscess, tooth pain, extremity injuries, lacerations, pelvic pain, abdominal pain and chest pain. He will coordinate care for an elderly woman in need of psychiatric services. Two of his patients will arrive after suffering acute traumas, one from a motorcycle accident and the other after a fall from a roof. One patient will show up complaining of frequent tremors in her arms and legs. After ruling out a few immediate causes, ordering an MRI and speaking at length with a Northwest Hospital neurologist, Dr. Waddell will discover that the patient's tremors are being caused by a transient ischemic attack, or a "warning" stroke.
"No day and no two patients are alike. Some people come in and you're not sure what's wrong. I begin gathering details and ruling things out. Eventually, I get to give them an answer," he says.
An answer, even an unexpected one, can be better than the uncertainty and confusion that accompany many emergency situations. Dr. Gregory Schroedl, an emergency medicine physician and Northwest Hospital's vice president of medicine, says patients are reassured to find the vast array of resources available to them at the hospital campus.
"One of the major benefits to patients choosing the Emergency Department at Northwest Hospital versus a free-standing emergency department or urgent care clinic is that they are being treated in a medical center where a full range of acute care services and specialty physicians are just minutes from the bedside," Dr. Schroedl says. "Whatever their healthcare issues and however acute, Northwest Hospital can provide for their well-being on-site. We also have the distinct advantage of being part of the UW Medicine Health System which, if needed, can provide the most sophisticated medical, surgical and trauma care available anywhere in the world."
As a detective, Dr. Waddell says his reward comes from solving his patients' problems.
"I will exhaust every resource available to me to find an answer. At our hospital, we have access to incredible specialty consultants," he says. "If we have a patient in cardiac arrest or who is having a heart attack en route to our emergency room, within 10 minutes I can have a cardiologist in the ER waiting for the patient's arrival."
While Dr. Waddell relies heavily on expert physician consultants, he says what most impacts quality care in the emergency room are the nurses, technologists and unit secretaries who work alongside physicians.
"We can't do our job without them," he says. "Every patient, no matter how ill, deserves personal, timely and efficient care. That begins the moment they come in the door and doesn't end until they are discharged."
Before beginning her shift in the Northwest Hospital emergency room, Dr. Jennifer Smith-Garcia goes through a series of small rituals. She puts a silver chain around her neck, from which hangs the letter "I". The small pendant is a reminder of her 3-year-old daughter Isabella. On her white doctor's coat is another talisman given to her by her sister on the day she graduated from medical school. The pin reads "be the change you wish to see in the world."
And before clocking in, Dr. Smith-Garcia recites a few words from the laminated card she keeps in her jacket pocket.
"...give skill to my hand, clear vision to my mind, kindness and sympathy to my heart."
She reads this Physician's Prayer, not because she is particularly religious she says, but because it gives her a chance to center herself before a busy shift. One of Dr. Smith-Garcia's patients today is Seattle resident Carol Maurer. She fell on the school playground where she works, fracturing her wrist.
When patients like Carol arrive in the Northwest Hospital emergency room, they can expect to travel through various stages of care. First they will be registered as a patient and then triaged by a nurse to determine how quickly they need to be seen by a physician. Next is the physician's exam and discussion. The doctor will then order any necessary diagnostic tests which could be simple lab work, an x-ray, CT scan or an MRI. Last is the patient diagnosis and treatment. The patient may be discharged with a prescription and recommendations for follow-up care, or the patient will be admitted to the hospital for further evaluation and treatment.
Carol and her husband Dan, who sits watchfully at her bedside, say Northwest Hospital is "their" hospital. It is the hospital where they delivered their three children. It is their community emergency room and the place they rely on when urgent health issues occur.
"Dr. Smith-Garcia is kind and compassionate. She asked how she could make me feel better and she was quick to provide care," Carol explains of her experience.
"Being checked on periodically makes a big difference," Dan adds.
Dr. Smith-Garcia never expected to specialize in emergency medicine. She planned to become a family practitioner or a pediatrician, but when she did her first rotation in a community hospital emergency room, she found she loved it.
"Every day, I come to work and do something good for someone who I don't know and who doesn't know me," she explains. "What an opportunity!"
A visit to the emergency room isn't typically an enjoyable experience. It is often filled with worry and anxiety. Coming in can feel like being thrust into a foreign country. People dress, talk and act differently. Everything feels strange and unfamiliar. Dr. Smith understands that her patients didn't choose to come to the ER and she works to put them at ease the moment she walks into the exam room. The most effective tool in her toolkit, she says, is being able to relate to people.
"I am a mother. I am a daughter. I am a wife. And I happen to be a physician," she says. "Becoming a mother has given me more patience. Now, I remember that the people I treat are also mothers and daughters and brothers and husbands."
Off the Clock
When thinking of an emergency room, it's easy to picture a scene from a movie – an ambulance, a team of doctors yelling and nurses running around trying to coordinate care in a frantic effort to save a patient's life. That does happen, but the majority of emergency room visits aren't nearly as dramatic.
Dr. Waddell is finalizing some patient paperwork and says goodbye to his last patient before clocking off. He is looking forward to heading home to see the people he calls his cheerleaders — his wife and two children.
"Even when they were very young, my kids would tell me to 'have a good shift' before I left for work," he says. "Without their support, I wouldn't have the energy or stamina to do what I do every day."
Like Dr. Waddell, Dr. Smith-Garcia is fueled by family.
"Being a mother has helped me become a better doctor," she says.
And they'll need the energy on the next shift, when they begin again.