ED Physics: Class is in Session

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altApplying physics lessons to daily life in the emergency department has never been more enjoyable.
“God does not play dice with the universe”

Applying physics lessons to daily life in the emergency department has never been more enjoyable.
“God does not play dice with the universe”


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The requirement to have studied physics before going to med school often defies logic and experience. Days go by when I do not use the Planck’s constant, the black body radiation spectrum and the results of the Michelson–Morley experiment. No. I’m afraid I am just one of those good old country boys who took physics in high school and again in undergraduate school at the University of Michigan because they said you needed it to get into medical school.

It took me only a few years to realize that they made you take calculus, physics, and certainly organic chemistry, in order to eliminate people from going into medicine. I went to school in the old days when they still gave out C’s, D’s and E’s. It was easy for them to make a mathematically correct, yet fundamentally useless, curve to use for grading purposes. How did we ever conclude that people who got an A in physics are better doctors than those who got a B? I want to see the sensitivity/specificity on that study.

I will admit that my physics course and labs where in an area they called classical physics, which constitutes an amalgamation of Newtonian mechanics/optics with added Maxwellian electrodynamics and thermodynamics. These really smart guys had already done the real work. I pretty much just needed to know when to use the formulas. Then again, at least we took our “blue books” with two pencils and a slide rule. Kids today don’t even need to understand the equations because they are built into their hand-held computers. What wimps.


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As an aside, when my son was about 12 years old, he found my slide rule in the desk drawer. He studied it intently and then asked what it was. I explained that all the great bridges, buildings and even the first entries into space had been calculated with this instrument. I was about to show him how to multiply ei when he asked the next question: “Dad, where do the batteries go?” I quietly put it down realizing this would be an exercise of futility. There are certain boilerplate assumptions which one generation does not share with the next. It’s the same reason I don’t date 25-year-old women, because I don’t want to explain the fact that the Beetles came after the First World War.

Back to physics. I readily admit we were light on Einsteinian physics. I studied it, but I really didn’t understand it, at least not very well. It never seemed right to me that if I was sitting in a ’55 Corvette – my favorite – going the speed of light, and I turn the headlights on, that there would be no headlight beam to illuminate the police cruiser as I was going by. So, why am I on this kick? Every year I pick out two subjects I’m going to study in-depth. In past years, it has been things like the U.S. Constitution, rereading the Aeneid in its original, Egyptian medicine …you get the idea.

This year I said I was really going to look at the assumptions that govern Einsteinian physics and try to believe in them. I am well aware that when I am falling off a 20-foot ladder I am not to believe in a simple gravitational attraction, but in something called a warp in the space-time continuum. This sounds like a bunch of crap to me, but I’m trying. I’m honestly trying to think about it in another way.

Then it came to me like relativity came to Einstein. All understanding is from a specific “frame of reference.” All things we learned in physics class are useful, but must be viewed from where we are. Remember the Corvette and the speed of light? We violate physics if we ignore our experience. I propose that we discuss ER physics with modifications to our definition. I don’t just mean the implicit trivial stuff like the fact that Ohm’s Law is merely an application, which can be applied to the circulatory system. No, I mean real stuff, stuff that we come up against every day. I propose developing a dictionary of physics we studied in our undergraduate curriculum and relating it to the emergency department. Let me start this project with some suggestions, but this is in no way complete or set in stone. Leaders are encouraged to send me suggestions for additions or modifications to this protean assemblage. A certain panache is, of course, required. Here goes:


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SPIN
Physics: In quantum mechanics, an intrinsic property of elementary particles and systems like atoms.
ED Physics 1. The story given to you by the patient who needs another Vicodin prescription. [i.e. my dog ate it; 10 dudes took it from me, etc…]  2. The story told to you by the resident who did not check the weak patient’s gait, or the reason why he’s late from lunch.

FIRST LAW OF THERMODYNAMICS
Physics: The assertion that energy is always conserved in a thermal phenomenon in a closed system.
ED Physics: The assertion that everyone will conserve energy by not getting off their ass and moving even when the department is going to hell unless acted upon by an outside force, such as the arrival of the pizza delivery man.

SECOND LAW OF THERMODYNAMICS
Physics: The assertion that entropy (disorganization) always increases in a closed system.
ED physics: The same (i.e. chaos gets worse and worse as the evening moves on). This is particularly true as it gets closer to the time you are to leave for home.

ESCAPE VELOCITY
Physics: The speed necessary for a body to escape the direct gravitational effects of the more massive body.
ED physics: The speed you must be moving to escape the nurse who wants you to see one more patient before you leave, directly related to your need to get home for your child’s soccer game times the chaos in the department. Please see the second law of thermodynamics above.

SPECIAL RELATIVITY
Physics: First stage in development of relativity (Einstein, 1905) referring to inertial frame of reference.
ED physics: The relatives of the patient in Room 5 think they are special and can occupy the entire department, eat food, play their music and use their cell phones next to the patient who has a pacemaker. Modification in rich people hospitals of special relativity: The family knows special people on the Board of the hospital and are willing to complain to them at any moment of the day and night.

GENERAL RELATIVITY
Physics: Not to be confused with special relativity. Extends the theory of relativity to the arbitrary accelerated frame of reference.
ER physics: The relatives of the patient in Bed 5 have now moved from special to general pains in the ass by wanting each and every doctor they know on the hospital staff called, just to make certain (see Heisenberg uncertainty principle) we have multiple, mediocre and uninformed opinions.

THE HEISENBERG UNCERTAINTY PRINCIPLE
Physics: A quantum principle that you cannot measure both a particle’s velocity and direction at the same time due to the effect of measurement.
ED Physics: You can never be certain when the resident of the admitting service will actually arrive in the department to see the patient you want admitted. It is also extende
d to the fact that you cannot actually measure both this resident’s intelligence or desire to do anything for the patient at the same time, because they are speaking at the speed of light in a language which you do not understand.

GRAVITATIONAL LENSING
Physics: The process whereby massive objects in the universe, such as stars, bend and refocus light and other electromagnetic radiation in different objects.
ED physics: The way the 600 pound patient in bed two bends the stretcher such that you cannot get a tech or a nurse to help said patient. This employs the law that bodies at rest will stay at rest until it is break time or lunch time. It also brings us back to entropy, which is the unavailability of a system to do work. Also related to this theory is the patient’s bending of the stretcher will probably result in the staff bending their backs, and they will be on off on Workman’s Comp for six months.

This is a family-friendly publication, so questions of the big bang theory – particularly those that take place in the closet where we store used backboards – length contraction, and black holes will await some future conversation. Again, your contributions to this area are invited.

While I’m trucking down this undergraduate memory lane, I’m considering doing a piece about why we took biology and the importance to study lower life forms if you’re going to work in the emergency department. Point to ponder: can amoebae get tattoos?

 

3 Comments

  1. Its late and its been over ten years since i took physics…but there has got to be something to the following statement:

    The number of tattoos and body piercings on an individual is directly proportional to the level of attention seeking whining he or she will engage in when informed of the nurse’s intent to place a 22 gauge IV

    Not sure if that makes sense, but it seemed to fit. Thanks for a great read…loved it!

  2. This demands serious research. The free skin to tattoo ration may be inversly related as to whether they buy the prescribed antibiotic along with the pain meds you wrote for. The permutations and combinatio of applied physics we could study in the ED is endless. Keep up the good work. I’m really glad you two wrote. I was starting to think that humor was going out of style. The next thing you know I will come down with terminqal political correctness.

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