Today was a generic Vertical day.

Vertical is what we call the walk-in side of the ED – get it, because patients generally remain vertical and don’t need a stretcher to lie down horizontally.

Meaning they are less sick.  Which isn’t always the case.

Today however, most of my patients were of the vertical nature.  Seeing less acutely ill patients can be frustrating for an Emergency Physician, since what we are there to do is save lives.  It’s sometimes easy to forget the human behind the medical case; here in Quebec, many people are not fortunate enough to have a family doctor so they present to the ED for things that would be much better served in clinic.  Patients don’t see the flow issues that we as health care workers see.  They don’t see the bigger picture of backlogs in the medical system caused by the daily flood of less acute medical presentations.

What they see, is their own suffering.

We as physicians are trained to explore the patient’s targeted history and physical for those nuggets of information that will lead to a diagnosis, or to something we can perhaps fix.

We aren’t as attuned to the story behind it all.

I met a lady today, a beautiful, elderly lady originally an immigrant to Canada.  She came to the ED because of a relatively minor complaint, but when taken into context with the rest of her life was actually a rather serious issue.  She had pain, and it was interfering with her daily activities and especially with her ability to care for her sick husband.  Unfortunately there was not much I could do for this in the ED, so I ended up referring her to see a specialist.

But what I did do for her, was sit with her in the exam room and listen a bit to her story.  Through her words I could imagine the sprightly, strong farmer she used to be, working the land, loving her husband, raising her children until deciding one day that life in Canada might be better for the family.  I could see the optimism and hope they set out with, as she retold the story.  I could also share in her regret, and her missing her homeland, as she told me how she now struggles on icy ground and even fell down a set of snowy stairs last year – all the while asking herself why on earth she uprooted her family and moved to this cold place.

All this, I heard as I ran my hands down her legs to check for edema, injury, neurovascular abnormalities.  I could almost read her life story in the scars on her skin and the song in her voice.  Finally we said goodbye, and I moved on with my day and she hers.

But she changed my day, she brightened it.

Later in the day I met another elderly lady, who drove me crazy.

I was trapped in an exam room with her for way too long, as she wouldn’t let me interrupt her pressured, rapid speech.  She told me her life story as well, in tangential snippets of information, all the while assuring me that each little thing she said was “so important, so important”.  I tried my hardest to listen, connect the dots, find out why she thought each thing she brought up was “so important” to the presentation at hand.  In truth, the diagnosis for her presenting complaint was simple and relatively trivial.  But her evaluation took longer than any other today, because of her personality.  I am generally an extremely patient physician; I listen, I care, I allow patients to open up.  But with this particular lady, I had to finally cut her off and leave the room with her still speaking – there was no other way.  I felt terrible, like a bad person, for dismissing this lonely elderly lady.  By the end of the day, when I encountered her again to discuss the results of her tests, she had clearly formed an attachment to me.  She held my hand, thanked me, told me she loved me, that she wanted to see me again and bring me a gift.  And of course, this made me feel even worse, for having such unkind thoughts towards her in my heart.  I smiled, shook her hand and wished her luck as she left with her husband.

I wish, somehow, that I knew a little bit about her background, her story.  What made her like this?  How is her home life?  Is she happy, or just overwhelmed with anxiety and psychiatric illness?

I may never know.

Vertical – a place many Emergency Physicians hate.

A place that at times makes me want to run screaming for the hills in aggravation.

But also, a place that can be like a national park where you could go for a walk and suddenly stumble upon a rare jewel.

Sometimes, vertical opens my mind, and my heart, to my patients.

4 thoughts on “Vertical

  1. Thank you for sharing this beautiful post. It is sometimes very difficult to slow down in the hectic environment of the ED. I used to do emergency work years ago, but now am focused on community-based palliative care. I teach Family Medicine residents and try to impart to them the idea of slowing down, sitting down for at least one patient, no matter how busy the ED is. It is good for the patient and good for the soul, and a brief reminder of why many of us are doctors.


  2. What a nice story. I think it is important to listen to patients stories and hear their concerns. While difficult in the context of an ER, we need to acknowledge their concerns and listen to them in a caring matter. Sometimes referring them to another professional like a nurse or social worker can be helpful to ensure a more in depth follow up.

    Hurting isn’t always physical it can also be psychological. I’m happy to know that their is still MD in ER who care, liscen and reflect on their practice. It is so important!! And this is what differentiate you from many healthcare professional who are mostly task on and on the Go-go.

    Continue the good work and remember you are never alone 😉 working as a team is always key!


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