Just like the show, but sadly, without George Clooney

I should be studying for tomorrow (today's!) morning Nutrition final, but since I'm having a hard time motivating, I figured I would write a bit about my 12 hour shift in the ER this past Friday.

I'm interested in emergency medicine, and since we don't get to rotate through the ER during our third year clerkships, I figured I need to start finding ways to see what it is like before I have am forced to decide on a direction during my 4th year. So Friday night, I signed up to do a 12 hour shift in our hospital's Level 1 emergency and trauma center.

The day started at 7am with our last 4 hours of class, some confusing administrative chaos, lunch with a bunch of my pregnant married classmates, ice cream, an attempt to spend the afternoon studying, and an hour of running, jumping and leaping after a frisbee in the hot Davis sun. (The latter was my first aerobic exercise in months and my first time moving my body in any serious way since the car accident last week. Needless to say, it was a little too much, and I probably should have started to take it easy when I realized my back hurt whenever I tried to breathe. Fortunately, due to the enormous amounts of caffeine I consumed that day and night to stay awake for my ER shift, I didn't get to feel anything until the next day...when I could barely walk.) After a quick shower, a soda and a powerbar, I began my 7pm-7am shift.

The evening started off quickly. Our hospital is the only trauma center for Northern California (outside the Bay Area) and I was in the section that was taking the sickest patients. The two resusitation rooms were full by the second hour, which was, unfortunately, about the same time as we received a family (mom, dad and young baby) who were in a car hit by a drunk driver trying to escape from the police. The baby was rushed into the pediatric ER and we could all hear her screaming from the hallway. The dad, immobilized in the stretcher and with blood pouring out of his ear, began to cry for his baby and wife. The scene was intense. The father had blood pouring out of his ear and the manner of his speech made me worry that he had a head injury. The mother had blood in her urine, which meant that she could have a dangerously broken pelvis. Patients in stretchers and the paramedics, police officers and firemen that had brought them in, continued to fill the hallway as the doctors rushed to stabilize those who were already in the resusitation rooms.

Earlier that day, a friend of mine who had done a similar shift to mine a few months ago told me that she had realized from that experience that she didn't want to be an ER doctor. She had seen a man die, and she could not see herself in a daily job where she was constantly seeing people at the most tragic, frightening and painful times in their lives. As I stood in the hallway not having any idea how things would turn out, I wondered how I would feel by the end of it. Fortunately, as things began to calm down (the ER had shut its doors to all but trauma patients since we were at 212% of capacity), good news began to come in. The baby was completely unharmed and we were able to tell the dad and bring him some relief. He and his wife were going to end up being relatively OK as well (his ear had been torn off and her pelvis had been franctured, but these seemed like minor injuries compared to what they could have been). In the slower parts of the night, I spent a lot of my free time getting to know both of them and relaying information from one to the other.

The process of care in a trauma setting is intense. Your clothes are cut off of you as a dozen hands poke you with needles, jam tubes down your throat, flip your body and inspect all your orifices, and prod deep into your wounds. It is violent and could be humiliting, if such a thing as humiliation was relevant during the moment of saving or losing life. But even though it is ruthlessly practical and methodical, there are moments of humanity that are always there. Like when the trauma surgeon's voice suddenly softens as he tries to comfort the patient he is about to cut into, or when, amid all the chaos of voices and machines, the doctor attempts to keep the patient informed on what is happening to him in broken spanish. To the doctors and nurses who do this job everyday, things could get old and methodical, yet most of them do not lose the respect they have for what the patient is going through.

In the middle of a trauma, things are unambivalent and absolute, and there is a certain clarity to every moment: everyone knows what needs to be done, and in that moment, they are all giving everything they have. During the early morning hours, we had a stabbing victim and later, a man who had most of the flesh torn from his arm after his car rolled over. Anywhere else, it would have been horrifying, but in the context of the resusitation room, things were simpler: these men were going to live and for them, the day was a lot better than it could have been.

My experience in the ER was intense but great. Something about it made me feel invigorated, useful and comfortable in my skin. At the same time, I am cautious about committing myself to a life of stress, tragedy and the absence of patient continuity. Thank god I don't have to make any decisions for a little while longer...