Life inside a busy emergency department
On our first episode of Season 3 of the Healthy Matters Podcast, we learn about the intense and unpredictable world of emergency medicine. More specifically, what it’s like for the team members who tirelessly navigate the chaos and life-saving moments of a major metropolitan safety net hospital – the busiest one between Chicago and the West Coast. I talked with Dr. Jon Cole, who began his life here when he was born at our hospital (a newborn intensive care graduate), and now spends quite a bit of time at HCMC as an emergency medicine physician and medical director of the Minnesota Poison Control System.
Dr. Cole describes HCMC’s emergency department – which is part of our comprehensive Level I Trauma services:
“It’s physically a really big place, taking up almost an entire city block, which as a medical student was really overwhelming. There are approximately 60 beds, and we care for more than 90,000 patients each year. In fact, we recently saw 287 patients in one day.”
As a Level I Trauma Center, HCMC has all the available resources to take care of any trauma patient who comes through our doors. HCMC is also a safety net hospital, taking care of anyone, regardless of their ability to pay. HCMC is truly a statewide resource, with two helipads and dozens of ambulances. People are literally coming to the hospital from all over the place.
“We take care of obviously a lot of the people who live in the neighborhood around us, which is true of any hospital. When we recruit prospective physicians, one of the amazing things we always get to talk about is we really have a tremendously diverse patient population that we’re honored to care for. We care for trauma patients who come to us from all corners of the state too, and sometimes even the Dakotas and Western Wisconsin as well. We really take care of everybody.”
What does a “typical” day look like in the emergency department? It’s anything but typical.
“Emergency medicine is the only specialty that’s defined by our patients,” said Dr. Cole. “We don’t hang a shingle and say, ‘we take care of hearts here.’ We hang a sign that says ‘emergency’ and the patients decide what the emergency is – and they come to us.”
As Dr. Cole explains the typical atypical day, we must explain the meaning of “triage” which means “sorting” in French. It’s the process of caregivers making sure that patients are receiving the best care for their condition as soon as possible. But this also means that if you’ve cut your hand and need a few stitches, you may have to wait until the patient arriving by ambulance with a heart attack through the back entrance is stabilized.
“When you come to the emergency department, you check in at the desk so we can get you in the electronic medical record. And then frequently the first person you talk to is one of the attending emergency physicians. There’s usually one doctor and two nurses working up front. And part of that is to begin the triage process. The downside, of course, means that some patients may have to wait for care – without understanding what is happening ‘behind the scenes’ in the emergency department.”
Since the pandemic, healthcare resources have been incredibly strained through every level of entry – and exit. Clinic appointments can be challenging to obtain, but emergency departments are always open – and unlike other areas in the hospital, they cannot say “stop – we’re full.” It’s a national phenomenon, and Dr. Cole experiences it firsthand:
“We are boarding patients in our emergency department much longer than we used to. This is one of the ways that we’ve had to adapt care and really change the fundamental way that we practice in our specialty, because there’s just not physical beds for them to go to upstairs, partly because the patients who are upstairs don’t have physical places to go back out into the community. It’s just backed up at every step of the healthcare system. Some people refer to emergency medicine as being the proverbial ‘canary in the coal mine’ because it’s such a dynamic environment. We always want to remain open, but it does get very stressful and stretches our resources sometimes.”
Minnesota is so fortunate to have compassionate, talented emergency professionals like Dr. Cole and his team always HERE to care for patients who are critically ill or injured. Hear incredible stories and insight from emergency medicine in our first episode of Season 3 of the Healthy Matters Podcast.
The Good and the Bad of Recreational Marijuana
In Season 2 Episode 6 of The Healthy Matters Podcast we talk with addiction medicine specialist Dr. Charlie Reznikoff about legalizing marijuana. As you recall, Dr. Reznikoff gave us The Inside Scoop on Addictions in Episode 4 of Season 1, and now he shares his thoughts about the current state of marijuana use in this country. Many states have now legalized it, both for medicinal use as well as recreational use. You are probably aware that a bill went through the legislature and was signed into law here in Minnesota last year allowing low-dose, hemp-based THC products.
“These products act just like recreational marijuana, and behave in the body just like that, but it’s only a low dose,” said Dr. Reznikoff. “They’re derived from hemp, which is related to marijuana, but not the same. And it has the active ingredient that is an intoxicant, so that that is available now throughout Minnesota in a variety of retail stores.”
Shortly after this podcast became available, the Minnesota legislature passed a bill that would legalize the use of recreational marijuana, likely going into effect on August 1.
We discussed whether this legal change would have a net positive, or a net negatives for individuals, and as a society.
“The most important number one benefit for the vast majority of people who use marijuana is that it brings pleasure and having some joy in your life,” explained Dr. Reznikoff. “I think it’s very reasonable that a lot of people are saying, ‘I want to have a little safe pleasure in the privacy of my own home to be able to use this intoxicant. It’s not that harmful. I use it appropriately.’ I think the number one upside for the vast majority of people is that it’s a relatively safe way to have a little bit of pleasure. And I’m not necessarily endorsing it, but I think that a lot of people just use it to relax.”
Is it a gateway drug to other drugs? What are the health benefits? Is it healthier to smoke, vape or eat cannabis? We hashed out these questions and more on Episode 6 of Season 2 of The Healthy Matters Podcast.
Yep. We’re talking about your colon.
We talk about everything on the Healthy Matters podcast, and on Episode 5 of Season 2, we’re going to prove it as we discuss the colon – otherwise known as the large intestine. We’re going to geek out about colons and stool today with my colleague, Dr. Jake Matlock, gastroenterologist, and director of the Division of Gastroenterology at Hennepin Healthcare, who launched the podcast with a claim that this organ is responsible for modern human society. I required more explanation.
“Your intestinal tract provides about three liters of liquid waste to your colon every day,” he said. “And your colon is responsible for taking that three liters of liquid waste and converting it to a small volume of solid stool and providing you the opportunity to eliminate that stool on a voluntary basis without your colon. We’d be like birds, we’d be just constantly leaking stool whenever we were walking around in the day, and we wouldn’t be able to get anything else done.”
Most of us haven’t thought about our intestines in that way. But let’s tuck that thought aside for a moment and consider some other real concerns that can jeopardize the health of your colon.
“Colon cancer is obviously a very important topic,” said Dr. Matlock. “It’s the third leading cause of cancer in both men and women in this country. The most important thing is to get screened, and I think that myself and my colleagues all carry a bias towards colonoscopy. We try not to let that bias come out because the most important thing is that you do something to get screened.”
That’s right – the best screening test is the one you’re going to do. We also talked about various inflammatory disorders that can impact the colon and other maladies that can cause discomfort.
Dr. Matlock shared how it’s a huge quality of life concern if a person’s bowels are not working in a way that meets their expectations, and if you’re having issues with your colon health that interfere with your life, you should talk to a provider. Changes can be made with your diet, your lifestyle, and occasionally, medication therapies can be implemented to help bring some regularity to your bowel function.
“If you do have colon problems, as difficult as it is, let your family know, because that risk for colon cancer is increased in first degree relatives of people with problems,” Dr. Matlock explained. “So, if you’ve had polyps, or colon cancer – let your family know because it changes their cancer risk.”
What do polyps look like? Why is colonoscopy prep so important? Are all polyps precancerous? We go there when we talk about your colon on Episode 5 of the Healthy Matters Podcast.