Day in the Life: Emergency Department

Happy Monday + welcome to another Medical Mondays and my third “Day in the Life” for residency!

I had one afternoon where I found out that I had a couple delinquent charts that I never knew existed(?!) so I went in a couple hours early to finish them off and completed them more quickly than I thought I would, so I went to my nap spot in the library and took a quick power nap before my shift.

(Yes, I have a nap spot, and yes, we have call rooms, but I didn’t want to bother my fellow residents who were on FM service by lying there while they were making phone calls and working on charts.)

Day in the Life: Emergency Department

5 p.m. – 1 a.m. (M) / 2:30 p.m. – 11 p.m. (T) / 11 a.m. – 7 p.m. (R) / 9 a.m. – 5 p.m. (W) 

Truth be told, I kinda felt a little like I’d been thrown to the wolves on this rotation. I had no idea how to work the EMR in the ED and there wasn’t really anyone around to tell me what was expected of me and/or where to start/what to do.

…but such is the nature of the emergency department (although I do feel like my med school ED experience was somewhat calmer…). I just did the best I could and eventually stopped floundering and feeling hopelessly lost (or at least, less so).

I alternated days between the urgent and emergent sides of the ED and on my first day, I got to sew up someone’s leg. The “urgent” side was akin to urgent care (e.g. back pain, headache, toothache, minor car accidents, lacerations) and saw lots of chest pain and shortness of breath cases on the “emergent” side.

I’d pick up charts after they’d been triaged and get them okayed by my attending, interview and examine the patient, and then run over their case with my attending and discuss my plan for them and put in orders. The “urgent” side was a lot more fast-paced whereas the emergent side required a lot more waiting for labs, consults, imaging, and making phone calls to potentially get patients admitted. Somewhere during the shift, I’d sometimes manage to fish out time to run to the call room to quickly grab my lunch and eat it, but mostly, I lived off the billion snacks I’d stashed into my pockets.

I had PALS training during one of my ED days and this mannequin set off alarm bells in my head while I was eating lunch, partially because I momentarily mistook it for a real child who’d for some reason collapsed under the table.

I worked with a different attending for almost every shift, so there were all kinds of different personalities to learn/work with/get used to.

I have never been a very assertive person, and didn’t know that I was supposed to tell my attending about each lab/imaging result–I just hounded the results and would update their charts as they came in because I didn’t want to bother my attending for every little thing.

That coupled with the fact that I use my phone to look up everything in the world didn’t translate too well with one of my attendings, because she thought I was just playing on my phone instead of seeing patients. (I guess it didn’t help that I was especially looking things up while working with her because I was slightly intimidated and didn’t want her to think I was stupid.)

In any case, she talked to me somewhat sternly after my shift and told me that residency goes by fast and that it’s meant to be a time to absorb as much knowledge as possible, because this is all we get. If you don’t know it after you’re out, you really just don’t know. She said she didn’t take residency very seriously for the first 6 months and one of her attendings talked to her the same way she was talking to me.

She also told me she tended to be especially hard on her female residents because as unfair as it might be, people tended to be more judgmental with young female residents so we especially had to know our stuff inside out to avoid being walked over by everyone else.

Truth be told, I was horrified by her interpretation of me not taking residency seriously, but didn’t want to sound super defensive since there’s actually a part on my evaluation form that talks about receptiveness to constructive criticism. I also knew she was taking the time to say all this to me because she wanted to help me improve, so I just went with it. I ended up having another shift with her later that week and she told me I did an amazing job, so hooray for redemption!

In other news, the Joint Commission told our hospital we were good to go so we were treated to waffles and ice cream in the cafeteria. It was glorious. :D

• Have you ever been to the ER for anything?
• Have you ever had a misunderstanding with someone? How did you handle it?