Sunday, May 1, 2011

Oh the 1

I had my first week in the ER this past week. Part of the lateness of this post is my attempt to completely block out that first day.

Yes, it was THAT bad!!

But thank goodness for a much better second day (that will have to wait until a later post)!

Day 1: I walked into the physicians room where I was supposed to be meeting the resident I would be working with. Instead, I was greeted by an extremely frustrated and chaotic attending who said " glad you're here. There's a head trauma in room 1, URI in room 2, and ringworm in ring 3. Take your pick."

I'm pretty sure I just stared at her for a few seconds before words even came out of my mouth. I reintroduced myself to her her, told her I had never been in the ER before, had no idea where these rooms were that she was speaking of, and didn't know where to go from there.

She looked at me like none of these were good excuses, and said "Umm, ok which one are you seeing first???" ...and continued to stare.

I figured why not go all out and take the head trauma!?!?

Really?? In situations like this, you'd think I'd pick "ringworm boy"- but nope, I figured, Go Big or Go Home. OK, that's not really true, b/c at that moment I REALLY would have rather gone home!!

But either way....

So I walk into little 2 year old head trauma room. Thank goodness this was more like "ran into the dining room table" head trauma as opposed to one that you would've seen on ER the TV show!! I take my history, do a quick exam and go out to present the patient to the doctor. So far, I'm just assumming this is like my primary care clinical.

So I get to the end of what I gathered, and she says, "OK- diagnose him and let me know what you're going to order for him."

HELLO!!! First of all, again, this is my FIRST, first SECOND here in the ER!! Second of all, even if I appropriately diagnose and treat this kid, I do not have access to order entry to do these things!!

Then, she tells me I need to "hurry up and put in a note" so that she can complete hers. What I later realized is the residents do all the work with the patient, put in orders, and then write a complete write-up (or note) that the attending then puts an addendum to.

Their oh-so complicated note writing goes a bit like this: "This MD agrees with previous note per X MD. See that note for full history, physical exam, and order entry."

Yeah, I know...feel bad for the big attendings. They get the crazy hard part of the job!

Unlucky for her though, she would be having a bit more work to do that day b/c I didn't have access to their notes. I mean, I entered one, but she wasn't allowed to just add an addendum to mine...because I'm a student!! She was SOOO ticked off when it wouldn't let her!

So my first 2 hours went pretty much like that. I had to tell myself to take nice, slow breaths several times. I figured that was the best option. Option 2 was to scream, which among the other screams in the ER may have gone completely unrecognized. And option 3 was to cry, but really, that's just not appropriate!! So slow, deep breathing it was.

And finally after 2 greuling hours alone, the resident decides to show up. THANK GOODNESS!!! Apparently, she was double booked at both the clinic and the ER for those 2 hours, and clinic won. Thanks for the notification!!!

Unfortunately for her, the attending jumped all down her throat the second she walked through the door as well, and the rest of the evening (until a new attending came on) went pretty much the same. The Peds ER really wasn't crazy AT ALL....but this woman sure was making it so! After she left, the last 4 hours of my shift weren't so bad at all.

So it was a nice welcome to the world of the ER (*note sarcasm). It was NOTHING like the PICU...which made me miss my job even more!! But the adventure must continue...and so I returned for day 2 in the ER the next day.

All I can say (for now) is the second day was much better. There was a much more relaxed attitude (thanks to a totally different attending being there), and there were even some the patient's expense of course...but either way, it made for a much better day!!

I guess when a first experience is horrible, it can only get better from there. If that's true, the end of my six week ER rotation should be INCREDIBLE!!!

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