«

»

Nov 20

Reflections on Emergency Medicine

I finished my Emergency Medicine rotation a couple days ago (technically 5 days ago, but I went in again for fun over the weekend). There have been many sleepless nights, but I learned a lot, and I definitely got to do way more procedures than I thought I’d be entrusted to do. The ER I worked in had 4 physicians, and I was technically supposed to spend 25% of my rotation time with each of them, but it kinda worked out that I worked mostly with two of them, had a 3-4 shifts with another, and saw the last one for about an hour, tops.

Reflections on Emergency Medicine

superstat
 

  1. “If you can’t derive contentment from being able to help 15-20% of your patients on a daily basis, Emergency Medicine isn’t for you.”
    My first preceptor told me that his preceptor told him this when he first started, and he found it to be very true. (I do as well.) While I do find EM interesting, I like having the time to get to know my patients, being able to follow up on them to see what happened, and you can’t really get that in an ER. (I also like being able to believe the best in others, and doing so in ER tends to not work out so well.)
  2. “See one, do one, teach one.”
    You get to do a LOT of procedures! (I’m at a smaller hospital; there were no residents while I was working, and I was the only student on the floor.) Not all of it will be by-the-book. A lot of the time, because the situation is so emergent, you can’t expect to follow every single step in order the way you’ve always been taught. You never know what’s going to come through those doors, so you needΒ to be adaptable! …and sometimes, when things are hectic enough, you don’t even get to see one before you do one. Make like Nike and just do it. (But if you really don’t have a clue as to how, please ask.)
  3. Be assertive!
    Don’t wait for people to show you how to do things. Take the initiative and ask them if they’d mind teaching you or walking you through. Now’s the time to be asking questions! Learn from the PA’s and nurses! Assuming you don’t have a background in the healthcare field (which I did not, unless you count 5-ish years as a volunteer interpreter at a free medical clinic!), they’ve been doing all this way, way longer than you have, and there’s a lot you can learn from them. Don’t waste those opportunities! One of the PA’s taught me to do a digital block and told my preceptor that I was a pro and to direct all future digital blocks + sutures my way. He’s a good soul. :O
  4. I probably wouldn’t do this for a living.
    And not because I didn’t like it. I’ve always found it intriguing, and I actually really enjoyed my rotation…but again, it’s not something that I would want to spend my life doing. I kinda knew this going in, but my rotation reaffirmed this in my head. As my preceptor put it, you have to be somewhat of a judgmental asshole, or patients will take advantage of you. I really like to believe the best about others and to give them the benefit of the doubt, and this environment unfortunately isn’t a place where you can really do that.. That being said, I think it’d be awesome if I could moonlight at an ER perhaps 2-3x a month once I’m actually out practicing. I’m planning on jumping back in here if I have any spare moments later on to see if I can learn more.
  5. People go to the ER for everything. Everything.
    I was already somewhat aware of this, but I severely underestimated how often it happened. The emergency room should be for emergent conditions, but people will come in for any reason under the sun, just because it’s convenient, and because the ER is obligated not to turn anyone away without at least screening them first. It’s become a dumping ground for all other fields of medicine, which is extremely unfortunate, and is a very, very significant part of why health care costs have racked up so high.

Memorable Cases

  • Psych patient who made up a story about just returning from Nigeria and having a high fever, bloody diarrhea and abdominal pain at a neighboring hospital (they were forced to shut the hospital down and redirect ambulances for 2 hours)
  • Sutured up a patient’s face after she got into a drunken argument with her neighbor and got stabbed in the face
  • Did my first ever digital block and sutured up a patient’s thumb after a sawing accident
  • Sutured up a very intoxicated patient who tripped over a table and fell into a bunch of boxes (I could see part of her skull; it took 20 stitches)
  • Applied anesthesia and sutured a patient’s scalp after a lifting accident
  • Counseled several patients with severe anxiety and depression
  • …we saw a patient in the cafeteria snorting what we assume to be cocaine on the security camera footage…

Notable Quotes/Conversations

  • “I know I’m drunk right now, but I just wanted to tell you that I really appreciate how much time you’re spending with me. It means a lot to me that you actually treat me like a human being.”
  • “…Ms. Fong?”
    You remember my name!
    “Of course I remember you! How could I forget? When I came back last week for my wound check, I was bragging to the entire hospital about you! I told them all that I couldn’t have received better care from anyone else. You’re a fantastic young lady and I really enjoyed talking with you!”
    Thanks so much! That really means a lot to me! I really liked talking to you too, and I’m so glad you’re doing better!
    “I meant every word of it! You did a great job on me!”
  • You’re good to go!
    “What do you mean? Weren’t you supposed to take the dressing out?”
    Ah. I actually did that already! I was just cleaning it up!
    “You did it so gently, I never even noticed!”
  • “I hope you decide to stick around here as a family doc! You’ve got great bedside manner, and we really need good docs here!”

Resources

Read about my other rotations here!

Permanent link to this article: http://www.fairyburger.com/reflections-on-emergency-medicine/

22 comments

Skip to comment form

  1. Lubna Naz

    Thought provoking and beautifully written article. We need these kind of awareness which make us more secure and safe from something bad happening. Thanks.
    Lubna Naz recently posted…15 Impressive And Cheap DIY Christmas Ideas To Do With Your KidsMy Profile

    1. Farrah

      Thank you! :]

  2. Amy

    I work in an ICCU, and spend a lot of time in the ED as well. I love your memorable patients, because I literally keep a list in my journal of (a) ridiculous scenarios that you just can’t make up, and (b) patients who touched my heart in ways I couldn’t imagine. I love that you’re documenting your experiences!

    1. Farrah

      (A) definitely keeps life interesting! There were so many things that happened where I was honestly questioning if I was hearing them correctly, but…apparently I was!

      And yay for (B)! :] I like keeping records of pretty much everything, but especially memorable patient encounters, because they help to remind me of why I went into medicine to begin with. :]!

  3. Amanda Nyx

    I read this entire post as if I was watching an episode of Scrubs. Hospitals are crazy places anyway, but ERs are just plain insanity. Good for you making the most of your rotation and gettin’ lotsa learnin’!! The bedside manner compliment is a big deal, that’s one of the hardest things to maintain in the modern age of medicine. Some doctors get so jaded their patients are nothing more to them than bodies and charts πŸ™
    Amanda Nyx recently posted…Blog Challenge Day 20: Fave FoodsMy Profile

    1. Farrah

      hahaha, awesome! I keep hearing so many awesome things about Scrubs, but have never actually watched it! (It’s been on my to-watch list forever, but augh! If only I could find the spare time to watch it! ;_; ) ERs are definitely an interesting place to be! πŸ˜› His comment (and the one from the guy whose finger I sewed up) honestly made my week! :] I was super happy that I actually got to “follow up” on him and to see how he was doing. :D! (That’s probably another reason why I can’t do ER for a living. I can’t take the no-follow-up thing! :[ ) I’m really, really hoping that I never get that jaded, but sometimes (especially in ER), I can really see why they would, and it’s really disheartening. :/

  4. Francesca

    Good luck!!
    Francesca recently posted…Sweet & Spicy Breakfast Hash {Paleo, Gluten Free}My Profile

    1. Farrah

      Thank you! :]

  5. Ali

    I read this post this morning before going to work and loved it. I was mostly feeling nervous for you for seeing really gross and crazy things, but I’m guessing you’re ok with that kind of stuff. I think I would pass out. But more seriously, congratulations on getting so many wonderful comments from your patiences. I’m sure that really helped reinforce all your hard work and dedication.

    1. Farrah

      I actually almost passed out on my first day and on the very first case (…sigh). I think that was actually because I was super dehydrated, but still, I was pretty disappointed in myself, haha. It has definitely gone up from there though, and thank you so much! I hope I’ll be an awesome doctor someday! *-*

  6. Mar @ Mar on the Run

    Wow, so interesting!! I cannot even imagine some of the cases that come in to the ER. Good luck to you!
    Mar @ Mar on the Run recently posted…Marathon Reflections: Thinking Out Loud v3My Profile

    1. Farrah

      Thank you! They’ve been really interesting! I’m actually getting ready to go back right now to just hang out and hopefully learn/do more procedures! :]

  7. Crystal

    I’d be fascinated to see what happens in an ER for a week! I bet the faux-Ebola guy was a little stressful! Wouldn’t it be great if there was an alternative people could use for those “This isn’t technically an *emergency*, but it’s 10pm on a Sunday and I need a doctor” circumstances?
    Crystal recently posted…Clean All The Things!My Profile

    1. Farrah

      Ohh, that was definitely a long night! I ended up staying for about 15.5 hours, haha. They pretty much sent all the surrounding hospitals into a contained panic in terms of how to deal with the “I-MUST-HAVE-EBOLA” patients who’d be coming in once it hit the press. Thank goodness it wasn’t real though!

      Agreed! I guess technically, there’s urgent care, but that’s not open all the time. Honestly, there really isn’t a perfect way to do it, but I feel like so many patients had no actual emergency. (A lot of them came in for super-minor 1-day coughs or cold symptoms just because they were dropping off a family member for a procedure somewhere else in the hospital and it was convenient to just “stop by.” x_x)

  8. genevieve @ gratitude & greens

    Farrah, you sound like such a lovely doctor to have! And seriously, a big high 5 for all the wonderful work you do for your patients!
    genevieve @ gratitude & greens recently posted…Kale, Swiss Chard, and Chickpea Soup with Sunchoke ChipsMy Profile

    1. Farrah

      Aww, thank you! I really hope I will be! I’m terrible with the test-taking side of medicine (sigh), but it’s comforting to know that I at least have the be-a-decent-human-being part down! *-* At least the former one is teachable (technically speaking πŸ˜› )!

  9. Emily @ Zen and Spice

    Haha great post. Hospitals can be pretty crazy places. I work in a heart hospital, mainly surgical patients and we’ve had a lot of crazies too!
    Emily @ Zen and Spice recently posted…Starting an At-Home Yoga PracticeMy Profile

    1. Farrah

      haha, it definitely keeps life interesting! (Makes for some really fun stories too. πŸ˜› )

  10. Susie @ SuzLyfe

    Oh. Emergency service. You never sit down, never surrender. I raise my glass to you.
    Susie @ SuzLyfe recently posted…Live Life Fully: Prana Clothing Review with Sweat PinkMy Profile

    1. Farrah

      Thank you! :O

  11. kerri mcgrail

    I love reading your medical posts. I am such a science/ health care nerd its not even funny. I have always been interested about emergency medicine. I love reading the memorable cases and the patient comments toward you- looks like everyone love you there!
    kerri mcgrail recently posted…Diet Rules that are Meant to be BrokenMy Profile

    1. Farrah

      Ahh! No idea how I missed this one, but thanks so much for your comment! <3 I'm actually in the ER again right now but as a resident! :D! My favorite part is still being able to talk with/actually help my patients! :]

Comments have been disabled.