There is a big difference between working an ED shift, and working a day of floor medicine/cards/surgery/ICU/PEDS. On the one hand, I go home at the end of my day, forget about everyone, and start anew the next day. On the other hand, while I’m working in the ED, I am working continuously. Literally. Pick up a chart, see the patient, order some labs/imaging, pick up the next chart, see that patient, order more labs, pick up a third chart, and a fourth chart. By this time, labs from the first patient may be back. Look at ’em, look at the x-rays. Make a decision and a disposition. Some patients will need interventions or procedures, which limits your ability to pick up the next chart, therefore your colleague picks up the next chart. Dinner? If I’m lucky, I can run over to the coffee shop for a snack. Staying hydrated? Forget about it. I’ve gone through entire 8 & 12 hour shifts without the need to urinate. Not that I can’t find time, I just forget. Finding time to eat and drink feels selfish on a busy day.

The point of telling you this is…there is no time for my brain to mull over “background” thoughts and ideas. I’m sure everyone reading this blog has things they like to think about during the day. Projects, bills, friends, vacation planning, weekend planning, grocery list, etc. On floor medicine, you have downtime to let all these things run through your mind, but not while working in the ED. Every single moment is consumed by patient care and medical decision making. It’s tiring!

As a result, when I get home, my brain not only needs to decompress from the activity of the ED, but also time to let these background thoughts that were supressed all day bubble to the surface. THe result? Three to four hours of almost manic, stream-of-conscious thinking, reading, internet surfing, project-finishing activity…very little of it medically related.

I’ll talk more about background thinking later. In the meantime, check out Electric Sheep, a visual life form created by the background thinking of a global network of computers…concieved and designed by my high school friend, Scott Draves. See Spot Blog to drop in on his daily background thinking.

PS…I was too busy today to think about each patient as a visitor to my blog!