About ER

So, I've been on my emergency medicine rotation for two weeks now. Remarkably little to talk about, however. I like the rotation, and I definitely feel like I'm learning, but I really don't think it would have been a good fit for me, for several reasons.

First of all, sometimes it's just too slow: usually, when the hospital is full and the ER is packed with ICU patients we don't have a place for and nothing moves. We're like the air control tower at the airport, with all these planes hovering around wanting to land before they run out of gas, and we're shuffling them around haphazardly, trying to make room (see dk, now that you've encouraged me, i'll be expanding the simile forever). This is both frustrating and a bit scary, since I doubt that the patients are getting as good care as they would in the ICU, and the lesser sick are pilling up in the waiting area. Meanwhile, the rest of us sit there with nothing to do.

On other days, like today, it's too fast. Again, patients pile up everywhere, but everyone has to be worked up at once, and the patients who are at all complicated rarely get a thorough evaluation. I feel like there is no time to think, which probably fine for the attendings and senior residents, but not great for learning. And if I do know what to do, it's very hard not to become mechanical and turn into a factory worker, who barely recognizes her patients as anything more than diseases.

I do have to admit though, that if I had to chose between slow and busy days, I would definitely pick the latter.

Today was just one of those days. It started off very slowly, but I had a few interesting patient who kept me busy. Then, around 3pm, chaos literally descended on the emergency room, and she brought her whole family with her. It started with few interesting traumas, which were followed by several very serious ones. At one point, when two related traumas came in, and I was left alone with the nurse to deal with the less urgent one (the entire trauma and ER team being only 5 feet away behind the curtain focused on the first patient), the patient I was with began seizing, with the high pressure causing blood to literally squirt straight into the air at me. The poor man turned out to be much sicker than first thought, and within minutes we had him intubated and heading for the CT scanner.

The onslaught, however, didn't stop. Traumas kept coming in, one every 15-20 minutes or so, occasionally interupted by possible heart attacks and acute abdomens. Within two hours, the ER was full and the packed gurneys trailed down the hallways. My less acute patients, who had been there all day, were moved into the hallways and watched in awe, as ambulance after ambulance came in, and the nursing staff began to feel the pressures and burdens of inadequate real estate and staffing.

Though I didn't leave until 90 mintutes after my shift ended, it reminded me of another thing I don't like about ER: the shift work nature of it. Some people love this about emergency medicine, but I find it hard to adjust to. I get attached to my patients and the team, and I feel crappy abandoning all, just because my shift is done. I think I'm one of those people who goes by inertia: slow and heavy to start, but once I get going, I kind of like to get the job over with. Ah well, to each his own. It is relief to have this reaffirmation that IM really was the right decision for me.