Pediatric ER

Finishing my month in the pediatric emergency department.

Highlights? Making some very cute kids feel less scared. And helping some scared parents realize that their kids will be okay. Learning to fix a nursemaid's elbow. Doing a lot of lumbar punctures. Taking medical command calls from ambulances. And learning a ton.

Frustrations? Parents who are angry they've had to wait a full hour (!) to see a doctor. ("My doctor's office is faster than this!") Especially for a child who is "feeling sad" -- nothing else. Or a kid who got in a disagreement with their parents over household chores. Or one who had a headache earlier but now feels fine. Or, parents who want a "full diagnosis" but refuse an IV for their child...or x-rays...or any tests at all. Also frustrating? Attendings who ask me at the end of my shift to "just help with a couple more things"...that then take two or more hours to finish.

Scary things? Seizing kids still freak me out. I know what to do...but still...

Week 1, so to speak

Okay, I haven't technically started emergency department shifts for real yet, but during orientation I had a couple shifts to get acquainted with my future home. I had forgotten how sick people are -- and, sadly, how much time we spend seeing patients who just want high-potency painkillers...or who want us to babysit their kids...or who insist that they need a CT scan for their stubbed toe that doesn't hurt anymore...or the drug abusers who want plastic surgery to repair the laceration they inflicted upon themselves while high. Hidden among them are the truly sick people. The trying-to-die-in-front-of-us sick people.

And in the first few shifts, I've seen patients with all sorts of problems. The normal -- pneumonia, heart failure, cholecystitis, elderly fall-from-standing patients. The semi-rare conditions like recurrent primary sclerosing cholangitis that I barely remembered from med school. The ticking time bombs like acute aortic dissections. Normal trauma cases, like the non-helmeted motorcyclist who went out for a leisurely ride and was hit at high speed by an SUV. The usual trauma cases -- "I stepped on a garden rake and it went through my foot" to "I slipped and my leg went under the lawnmower." The violent, psychotic patients who try to break everything in sight -- and then start crying -- and then threaten to kill your family. And the demented, frail older patients who are just plain confused and decide to start hitting you while you're performing an ultrasound to diagnose them.

My first month will be split between anesthesia (airway/intubation skills) and ED ultrasound. It's probably the easiest rotation of the year, so I better enjoy things I while I can!

Looking Ahead

Match Day has come and gone. And in June, I will start work at Rhode Island Island Hospital, as part of the Brown University residency program in Emergency Medicine! Between now and then, I'm also getting married, graduating from med school, and possibly buying a house or condo.

Busy much?

Hi.

Hi.

It is an interesting time. I'm done with clinical rotations, and now I fill my time by teaching first year med students, finishing my current research project, and going to the gym. I even submitted entries to a few medical student essay contests. Yes, an essay contest just for med students. Because we're known for being such excellent writers.

Anyway, things have been slow. Fortunately, for the last week, Karen and I have been on semi-vacation in Minneapolis, working on some in-person wedding planning. We visited our ceremony and reception sites, tasted some wedding cake samples, and finished most of our gift registry.

I've also been reading for fun -- Paul Starr's "Social Transformation of American Medicine" -- and keeping up my workouts. I've also been playing Wii sports for 1-2 hours a day. Tennis + boxing = very sore shoulders.

Tomorrow we fly back to Cleveland. And Monday we get emails to say whether we matched (yay!) or not. And Thursday is Match Day.

And then we can start planning next year for real!

Where does the time go?

May. Late May. Time to start blogging again.

I'm finishing my first of two consecutive months of ER rotations. I've been building up some pretty high expectations for these months. Since I've been thinking all through med school that emergency medicine is where I will end up, it's hard not to make conclusions about my future career based on these shifts. I need to recognize that there are ups and downs to it, much as there are in other fields of medicine and, for that matter, in any sort of job. But, perhaps more importantly, I need to look through these ups and downs and see whether the underlying responsibilities and daily activities of an ER doc are something that I could do for a few decades.

So far, so good.

My last few shifts have been particularly rewarding. I feel like I'm finally getting a sense of how the department works, how to most efficiently manage the patients I'm seeing, and how to handle some of the basic procedures performed in the ED. I've done a few I&Ds, a few laceration repairs, and tonight I did my first digital block. Nothing fancy, but it feels good to have at least some basic skills other than interviews and physical exams.

For non-medical folks: you'll notice that I'm using a variety of acronyms, and most of them are interchangable. People have heard of the "ER" and the classic TV show of that name. Some emergency physicians (EPs) now prefer the term ED (emergency department) since the physical space is clearly more than just a couple rooms. And EM (emergency medicine) encompasses the field as a whole.

Okay, 2:54am. Time for bed.

Happy 2008

Hello!

It's 2008. Things I have celebrated (?) so far in 2008 include:

- the start of my surgery rotation! Seriously. Waking up at 4:30am is one of my favorite pasttimes.
- the arrival of springtime in Cleveland (65 degrees in January?) followed by the return of actual winter
- my new hatred for Bank of America. I really, really loathe them. If every BofA were to spontaneously erupt in a shower of giant fireballs, I would feel much better. Maybe I can just hope that their purchase of Countrywide (one of the leading sub-prime lenders in the country, I think?) will somehow lead to their own little Enron-style corporate implosion. I doubt it, but one can hope. Grrrrrrr. Fireballs.

One more thing

I hate my upstairs neighbors. While there are many things I like about this place, the neighbors are not one of them. The loud rap music blasting out their windows at 12:04am on a Monday night is just one reason I hate them.