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!