Thursday, February 3, 2011

Notes from the ER

I started a month of shifts in the emergency department today. As I rode the train into work this morning, I looked around me at all of the people heading to work, and wondered who of the millions of people sharing a perfectly fine morning commute, would find their way into the ER and into my care. Kevin calls this a baseline of badness which exists every day. Every day someone out there is going to have a heart attack. Every day someone is going to cut their finger and need stitches, some one is going to bang their head at the gym and need stitches, someone is going to break a bone in their foot playing soccer. Although, I am 100% sure that I have no aspirations to be an ER doc, it is sort of fun to play one for a month. The thing about the ER is that you take care of everyone: old, young, rich, poor. It had been a while since I had the majority of the responsibility for caring for patients, coming up with my own evaluation, making my own diagnosis, ordering my own tests and I was worried for the first five minutes that I might have forgotten everything but somewhere tucked in the depths of my brain are millions of facts about random illnesses, and the experience of seeing hundreds of patients before today and somehow it all comes back. No mater how many months ago it was that I last took care of cute little two year old or how many months it has been since I last saw a big bad eye infection. It is amazing how our memories work, one look at a patient and all of this knowledge pops into my head. I might have forgotten the dose of Augmentin to use or the first line choice of IV antibiotics for pneumonia but those are the things you can easily look up. The best way to examine a two year old, all the tricks learned along the way about how to look in their ears with out making them scream, those things are the more important stuff that you cannot easily look up on a smart phone. My first shift in the ER while exhausting and dehydrating was fun. It was fun to not know what was coming in the door, to be surprised at what the patient's real agenda was for coming to the ER. And I left, feet tired, needing a drink of water and a trip to the bathroom for the first time since the morning, but I felt I helped patients, stitches were placed and removed, pregnancy was averted, mothers were calmed, antibiotics were started and we sent them on their way reassured that they would get better. While I do not wish anyone a trip to the ER, I hope that if you go you have a good experience. Martha Stewart recently blogged about her own trip to the ER check it out here.

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