Happy Monday!!! Is it freezing where you are today? It is super cold here in Indianapolis. I think this extra cold winter is helping me prepare for moving to Minnesota.
Last week I started my emergency medicine rotation. This is the second of my 3 required fourth year rotations. The first one I did was my sub-i or sub-internship in the ICU, and I have radiology next month.
So far, I’m actually really loving the emergency room. Honestly, I wasn’t expecting to like it at all. But, the things I thought I would hate are actually the things I like! I thought I would dislike being the first person to see the patient and then having to pass them off to someone else if something was really wrong. But, it’s really nice seeing the patient, figuring out what they need, and sending them on to internal medicine, GI, surgery, or whatever. I feel like I’ve done my job and now that patient will get the care they need. I think after a while I might get sad I don’t get to see what ends up happening with that patient, but at the moment, I don’t mind!
Along those same lines, I thought I would hate that there’s no continuity with patients, but again, I’m liking it! Once you see a patient it’s your job to make sure nothing life threatening is happening. You treat them as best you can, and then they leave. I had a patient with a headache yesterday and after a few hours in the ER we sent her home with some ibuprofen. I will never know what was causing her headache. But again, I don’t mind. It’s actually kind of nice knowing you don’t have to see them again! Strange.
Something else I’ve come to realize while working in the ED is that people will come to the emergency room for ANYTHING! People use the ED as their primary care office. People come to the ED instead of urgent care. I’ve seen patients with neck pain lasting 3 days and literally no other symptoms. I’ve seen patients with a cough for 2 days and NOTHING else. I’ve seen patients with a headache that’s been going on for 10 years. To all these patients I say, “why did you come to the ER???” Most of them say they “just wanted to get checked out” or, “I had a friend here in the hospital so I thought I would come down and get my neck looked at” or “I just couldn’t take it anymore”. It’s very interesting.
Of course, I’ve seen lots of people who really need to come to the emergency room. I had a patient with an ectopic pregnancy the other day, one with stroke-like symptoms, and patients from car accidents.
I think it’s an honor to care for people at any stage of their illness, but it is cool to be the one to see illnesses in the most acute phases.
So here’s what my day is like: (If you’re not interested in medicine, you can just skip to the bottom and leave a comment telling me to stop rambling and writing long posts about my rotations 😉 )
Wake up, eat lots of oatmeal or greek yogurt with blueberries (my favorite breakfast lately)
Workout (with all the snow, I’ve been doing lots of home workouts on my treadmill but yesterday I finally got into the gym)
Since I’ve been running a lot, I wanted to give my knees a break and cycle for my workout yesterday. But there weren’t any spin classes going on at my gym. So, I went on youtube and found a spin class there! You just follow right along! How am I just figuring this out? Now I can spin any time!
Get ready (consists of putting my wet hair back in a clip and putting on my
pajamas scrubs.) Since I can’t wear scrubs at Mayo (you were a SUIT every day!!!) I’m savoring every last day of scrub wearing I get. They are just so comfortable!!!
Go to the ED. Each student has 15 shifts this month. My shifts are all over the place, but most are in the evening and night. Each shift lasts 9 hours.
Once I get to the ED I drop my stuff and head to a computer. We have a census that lists all the patients, where they are, and what they need. At first they will be in triage. Then they come to a room and will be evaluated by a nurse. Once they are ready to be seen by a physician, a little green box pops up that says, “MD Eval”. Whenever I see a green box by a patient, I scroll over to the medical student column and put my name down. The MD Eval box then changes to say TIP or treatment in progress.
Before I see a patient, I will look up their records in the computer to see when they were in the hospital last. Often, there is a discharge summary from a hospital stay not too long ago. This is super helpful because it lists all the patient’s medical conditions and what happened when they were last hospitalized. It gives me a good general picture of the patient before I go in to speak with them. Also, it tells me when they were in the ED last. A few nights ago, I had a patient who had been in the ED the past 2 nights. This was his third night in a row coming in!
My attending says that anytime a patient comes to the ED back to back for the same problem, you need to examine them twice as hard to make sure you haven’t missed anything.
Then I head in to speak with the patient. I say, “Hi I’m Andrea. I’m the fourth year medical student on the team today. If it’s okay with you, I’ll chat with you for a bit and you can tell me everything that’s going on. Then our staff doctor will see you as well. We will make a plan together and get you everything you need. Does that sound okay?” I’ve never had anyone give me a hard time about being a medical student not a doctor. But if someone ever did, my go-to response is, “the best thing about medical students is that we have more time than the doctors. So you can tell me everything you want. Our staff doctor will see and examine you as well. Don’t worry, you will get excellent care.”
Then I talk to the patient. I ask them what brought them in, how long it’s been going on, what it’s like, what makes it better, what makes it worse, what their biggest concerns are, etc. I ask them about their past medical history, family history, and social history. Then I do a physical exam. After that, I will tell the patient what I think is going on. I’ll say, “I’m so sorry about your abdominal pain Mrs. X. It sounds like this could be a viral illness but we want to make sure nothing else is going on. I’m going to get a urine sample to make sure you don’t have a UTI and make sure you’re not pregnant. After that we might run some blood tests. If those don’t tell us anything, we might do some imaging of your belly and maybe a pelvic exam. But right now we’ll start with the urine. Does that sound okay?” Then I tell them I will chat with the staff doctor and tell them everything we talked about. I tell them the doctor will come in to see them as well.
Then I leave.
Then I write up my note and fill in the physical exam findings. Most doctors will write the note in the room, and I’m trying to do that. But I haven’t perfected it yet so often I will take notes on a separate sheet of paper, formulate my thoughts after I leave the room, and write something more cohesive after the fact.
Then I walk to the area where all the doctors are and stand there like a loser until someone looks at me.
I ask the doctor who looked at me if they have time to staff a patient. If so, I present the patient to them. I tell them why the patient is here and what relevant symptoms they are having (some people have really irrelevant symptoms like ear lobe hurts when they came in for a sprained ankle). I tell them what I think is going on, what I think we need to rule out, and what I think we should do. I’m finding that I am generally more conservative with my plans than the ER doctors. I never suggest doing as many things as we end up doing. But I’m learning.
Lastly, the doctor and I will go into the patients room together. The doctor will ask a few questions to make sure my story is correct, then do their own physical exam. We explain what we are going to do to the patient and then we leave.
And then I get another patient and do that all over again. I try to follow the results as they come back for each patient, but often everything is normal and the patient goes home before I see them again.
About halfway through my shift I sneak away for a meal. It’s been chicken and rice soup all week. I made a HUGE batch with homemade broth and it’s delicious.
And that’s the ED! Did I completely bore you??
Have you ever been the the emergency room? What was it like!?