2000: I arrive at the hospital. The waiting room is so ridiculously crowded that some patients are forced to sit on each other's laps. Luckily, we're understaffed tonight.
2010: I'm assigned an OD patient. I'm supposed to do checks on her every 20 minutes. I do one and subsequently forget for the rest of the night. Eh, she's got nurses.
2030: I see a patient who is here for "rectal abscess", although she's placed in the hallway so I don't know how I'm supposed to look at it. It doesn't really matter though, because when I speak with this lady, she's clearly floridly psychotic. She keeps telling me she needs a penicillin shot for pneumonia. That was pretty much all I could understand, because she talked like Golem on meth.
I went back to my attending: "This woman is crazy. I can't understand a word she's saying."
Fortunately, after making her wait another hour, she left.
2050: Suicide attempt patient. Surprisingly, it wasn't me.
2120: I "get to" sew up the palm of this 15 year old kid who got his hand stabbed in a knife fight. I never want to sew up a palm again. It just wouldn't get numb and the skin kept breaking. Plus the kid was a complete wuss, considering he had just been in a knife fight. And his girlfriend kept leaning into my sterile field to see how I was fucking up. And his girlfriend looked about eight.
"Aw, is that your little sister?"
"Naw, that's my woman."
I sort of got it to stay together though. The attending looked at my work and thought it looked OK, but said I would have been better off using a mattress stitch. I was like, "I don't know how to do a mattress stitch... I'm a freakin medicine intern. I'm lucky I can do this at all."
Me: "So what was worse: getting stabbed or when I sewed it up?"
Pt: [no hesitation] "Getting sewed up."
2200: I slam my right ring finger in the bathroom door. For about two minutes, all I can do is hold my finger and mouth the word "Ow" over and over. Will I get back into the trenches despite my injury? Do I have a choice?
2230: Woman comes in smelling so strongly of alcohol, I feel like I'm getting drunk just talking to her. If only.
2300: I run into my arch-nemesis Jessica in the hallway, who I have discovered I have to spend my first ICU week with. I do the hardest thing I've had to do all night, which is I flash her a small, friendly smile. God, I hate her.
2330: If you really want to make a little kid scream, all you have to do is pull out a tongue depressor. I don't know why, but those things freak them out.
0010: My awesome attending brings in a guy with a forearm laceration just because she knows I want practice with the lacs. She doesn't realize I've gotten all jaded from the last lac. Fortunately, this is a nice straight cut and it goes swimmingly.
0030: One of the university hospital interns David gets snooty with me (again). He's decided to do his own blood draw, for reasons that completely escape me, and he's asking me where the tubes are and I don't know because no other doctors draw their own freakin blood. I don't know what is up with these university guys... they're all really cute and they're all really arrogant. There is nothing worse than a cute, arrogant male doctor. I wanted to smack David upside the head when he started lecturing me on the correct INR for a person with a valve replacement. I didn't, but next time I will. Watch out, David.
0100: Little boy with cerebral palsy having serial casting had cast placed today and it's too tight and needs to be removed. The attending saws it off, saying every five minutes: "I hate doing this" or "I almost never saw off casts" or my personal favorite, "I don't know what I'm doing."
0200: Patient in stretcher in hallway with no legs tries to get my attention:
Pt: "Nurse! Nurse! NURSE!"
[I ignore all cries of "nurse"]
Pt (looking right at me): "Are you a nurse?"
Pt: "Do you work here?"
Pt: "Can I have some Klonopin?"
0245: Guy with history of neck cancer comes in because he had dental surgery three days ago and ever since, that side of his face is really swollen and painful. The attending nearly gives him a heart attack when she tells him she thinks his obvious tooth infection may be a recurrence of the cancer. (We do a CT and it's negative.)
0300: Girl on suicide watch makes a break for it. I hear the door to the ED slam, a nurse yells "Shit!" and runs out after her. She's retrieved.
0330: I decide to take a break. Because I missed the food cart, I go upstairs and steal some crappy cookies from the on-call teams.
0400: Post-menopausal woman with vaginal bleeding. She's got every possible risk factor for endometrial cancer, like she got the textbook and was just reading it to me. I wish every patient were this easy: refer to GYN.
0440: "Do I really have to do a rectal exam on the demented nursing home patient in room 4?"
0500: I've got 2 hours left. Now the game is: how few patients can I get away with seeing in the next 2 hours?
0510: I see a 30 y.o. woman with symptoms of ovarian cyst, history of ovarian cysts, but for some reason, her mom thought she had appendicitis and got her all anxious. While I'm taking her history, I find out that she just started smoking three weeks ago. Because I'm in no hurry, I launch into a little lecture I call, "Smoking causes more than just lung cancer." She's nodding and saying that she'll try to quit.
Then I ask about drug history. She smokes crystal meth daily and apparently traded it for cigarettes 3 weeks ago. I suddenly feel really stupid for the cigarette lecture.
0530: I get out the ultrasound machine and attempt to visualize this alleged ovarian cyst. I've gotten to the point where I can turn the US machine on REALLY well, but that's about it.
Pt: (looking at screen) Oooh, is that my ovary?"
Me: "Uh........ yes."
Pt: "Does it look like there are cysts there?"
Me: "Uh.......... you know what? I don't really know how to use this machine."
A rare honest moment.
The attending comes in and does a really good US, rupturing the cyst in the process, causing the woman to have 10/10 excruciating pain. Go diagnostic medicine!
0550: IM morphine SUCKS. I am never giving it to anyone again. The shot hurts and it doesn't appear to relieve anyone's pain at all.
0600: Little girl with history of sore throat now have blood in her urine and puffy face. Oh fuck, is this glomerulonephritis? I've never seen that before and I know it has a really good prognosis, but I'd really rather not tell this woman I think her daughter might be in acute renal failure.
Mom: "So what do you think is wrong with her?"
Me: "Um.... it could be... a urinary tract infection."
Mom: "Oh, so--" [I've already run out of the room and am walking down the hall]
0650: The next shift begins to filter into the hospital.
Attending: "Well, it looks like we made it."
GOD you have just summed up the uniquely, floridly painful month in the ED during my intern year. Somehow though, in always managed to get stuck with reproductive age females with abdominal pain or post menopausal females who could not retrieve their pessaries :(ReplyDelete
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I think some people will read this post and think that EM sounds like the most amazing specialty ever. I find that kind of amazing.ReplyDelete
I do like being in the hospital at night. I think it's because it's quieter and fewer people bother you though, not because of the cast of characters that comes to the ED at that time.
There are things I loved about EM, namely the procedures. But the most telling thing is that I used to dread each shift with every fiber of my being.ReplyDelete
I agree, the procedures can be really fun -- IF you don't have 15 other patients who need to be seen at exactly the same time! Then they are stressful.ReplyDelete
I thought I really liked EM, until I realized that I was watching the clock every shift. I realized that if I started each shift thinking, "Only 12 more hours, only 10 more hours, only 6 more hours, etc." that it was going to be a painful career for me. I will say, the time did go by fast. On the negative side, there's nothing that sucks more than to have your shift finish, but have to stay around anyway to tie things up -- for two more hours. At least on medicine I never expected to be able to go home.
I hate shiftwork. I like knowing I have X amount to get done and then I can leave. I also hate not knowing any of the patients... I prefer continuity of care.ReplyDelete
I agree that IM morphine does not work. Not only that, the bruise didn't go away for two weeks. My sprained ankle bruise (Separate incident =/) went away faster!ReplyDelete
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