Reflections on Emergency Medicine

I finished my Emergency Medicine rotation a couple days ago (technically 5 days ago, but I went in again for fun over the weekend). There have been many sleepless nights, but I learned a lot, and I definitely got to do way more procedures than I thought I’d be entrusted to do. The ER I worked in had 4 physicians, and I was technically supposed to spend 25% of my rotation time with each of them, but it kinda worked out that I worked mostly with two of them, had a 3-4 shifts with another, and saw the last one for about an hour, tops.

Reflections on Emergency Medicine

1. “If you can’t derive contentment from being able to help 15-20% of your patients on a daily basis, Emergency Medicine isn’t for you.”
   My first preceptor told me that his preceptor told him this when he first started, and he found it to be very true. (I do as well.) While I do find EM interesting, I like having the time to get to know my patients, being able to follow up on them to see what happened, and you can’t really get that in an ER. (I also like being able to believe the best in others, and doing so in ER tends to not work out so well.)
2. “See one, do one, teach one.”
   You get to do a LOT of procedures! (I’m at a smaller hospital; there were no residents while I was working, and I was the only student on the floor.) Not all of it will be by-the-book. A lot of the time, because the situation is so emergent, you can’t expect to follow every single step in order the way you’ve always been taught. You never know what’s going to come through those doors, so you need to be adaptable! …and sometimes, when things are hectic enough, you don’t even get to see one before you do one. Make like Nike and just do it. (But if you really don’t have a clue as to how, please ask.)
3. Be assertive!
   Don’t wait for people to show you how to do things. Take the initiative and ask them if they’d mind teaching you or walking you through. Now’s the time to be asking questions! Learn from the PA’s and nurses! Assuming you don’t have a background in the healthcare field (which I did not, unless you count 5-ish years as a volunteer interpreter at a free medical clinic!), they’ve been doing all this way, way longer than you have, and there’s a lot you can learn from them. Don’t waste those opportunities! One of the PA’s taught me to do a digital block and told my preceptor that I was a pro and to direct all future digital blocks + sutures my way. He’s a good soul. :O
4. I probably wouldn’t do this for a living.
   And not because I didn’t like it. I’ve always found it intriguing, and I actually really enjoyed my rotation…but again, it’s not something that I would want to spend my life doing. I kinda knew this going in, but my rotation reaffirmed this in my head. As my preceptor put it, you have to be somewhat of a judgmental asshole, or patients will take advantage of you. I really like to believe the best about others and to give them the benefit of the doubt, and this environment unfortunately isn’t a place where you can really do that.. That being said, I think it’d be awesome if I could moonlight at an ER perhaps 2-3x a month once I’m actually out practicing. I’m planning on jumping back in here if I have any spare moments later on to see if I can learn more.
5. People go to the ER for everything. Everything.
   I was already somewhat aware of this, but I severely underestimated how often it happened. The emergency room should be for emergent conditions, but people will come in for any reason under the sun, just because it’s convenient, and because the ER is obligated not to turn anyone away without at least screening them first. It’s become a dumping ground for all other fields of medicine, which is extremely unfortunate, and is a very, very significant part of why health care costs have racked up so high.

Memorable Cases

• Psych patient who made up a story about just returning from Nigeria and having a high fever, bloody diarrhea and abdominal pain at a neighboring hospital (they were forced to shut the hospital down and redirect ambulances for 2 hours)
• Sutured up a patient’s face after she got into a drunken argument with her neighbor and got stabbed in the face
• Did my first ever digital block and sutured up a patient’s thumb after a sawing accident
• Sutured up a very intoxicated patient who tripped over a table and fell into a bunch of boxes (I could see part of her skull; it took 20 stitches)
• Applied anesthesia and sutured a patient’s scalp after a lifting accident
• Counseled several patients with severe anxiety and depression
• …we saw a patient in the cafeteria snorting what we assume to be cocaine on the security camera footage…

Notable Quotes/Conversations

• “I know I’m drunk right now, but I just wanted to tell you that I really appreciate how much time you’re spending with me. It means a lot to me that you actually treat me like a human being.”
• “…Ms. Fong?”
  You remember my name!
  “Of course I remember you! How could I forget? When I came back last week for my wound check, I was bragging to the entire hospital about you! I told them all that I couldn’t have received better care from anyone else. You’re a fantastic young lady and I really enjoyed talking with you!”
  Thanks so much! That really means a lot to me! I really liked talking to you too, and I’m so glad you’re doing better!
  “I meant every word of it! You did a great job on me!”
• You’re good to go!
  “What do you mean? Weren’t you supposed to take the dressing out?”
  Ah. I actually did that already! I was just cleaning it up!
  “You did it so gently, I never even noticed!”
• “I hope you decide to stick around here as a family doc! You’ve got great bedside manner, and we really need good docs here!”

Resources

• UpToDate

Read about my other rotations here!