Emergency Room 

I am SO sorry I got so behind on my blog! The last several months have been crazy, full of traveling and interviews for residency and just all around busy-ness! 
Mid-August through mid-September I had my ER rotation. The awesome part of ER docs jobs is that they work 10-15 shifts per month. Their shifts are 10-12 hours, so they work less days. That said, I had the first 2 weeks of my 4 week rotation completely off work! I wish I could say I was super productive, but I basically caught up on reading, started a knitting project, and netflixed my way to boredom. 
September I officially started my rotation! I walked in, set my bag down, introduced myself, and immediately heard “is that the student? Send her in here!” I went into the room to which I was being called & was told to hold this man’s black and blue and green foot that was clearly not at the correct angle. All of the sudden, the doctor snapped his knee and his ankle was in place… I felt everything! The crunch, the man tense up and scream bloody murder, the ankle bones in place, and the hard indurated ankle tissue loosen into a squishy mess. It was disgusting. He had apparently jumped off of a building while drinking. Story of my- well, no, that’s just plain dumb.
The rest of the rotation was similarly exciting. We had a case of recurrent priapism we treated with phenylephrine. We saw numerous heart attacks, the most exciting of which was a post-coital (ahem… Post-intercourse) heart attack that saved a man’s life (his coronary arteries were almost 100% blocked and without that heart attack, he wouldn’t have come to the ER and could’ve died at home at any moment!). We saw tons of scorpion stings- which burn a bit, but mostly have a systemic neurological effect including feeling restless and causing your eyes to bounce back and forth for hours on end (medical term: nystagmus). It’s neat to see because we always learn about nystagmus but never see it…. But it seems awful to go through. We had a Iife flight patient who had been bitten multiple times by a Mohave rattlesnake (ok, why do I live in scary Phoenix?!) We unfortunately saw a lot of suicidal teenagers. As much as I hate to say it, the newness and shock of it wore off after our 7th or 8th admission. Then, as all medical conditions, it became just another patient to treat, getting the appropriate referrals and care they required. 
We saw drug and alcohol overdoses. Lots of them. Which, similarly to the suicidal patients, seemed less shocking after our 10th or 11th case. Sickle cell crisis. MALARIA (which would’ve been more exciting had the man not walked in and said “I’ve had malaria before and I just got back from Africa and have it again”). We saw fractures of ribs, tibia, fibula, ulna, radius… Basically broken arms, legs, and everything in between! Lots of motor vehicle accidents, including one where the mans nipple was ripped off by his seat belt due to his nipple ring…Yikes. We saw elderly people who had been found on their floors after being there for days… Medically stabilizing them is a challenge and unfortunately this is a common problem. 
Procedure wise, my doctor let me do a TON, which I loved. I did stitches on more people than I can count… Cuts to the eyebrow, cuts to the wrist, cuts to the fingers, cuts to the toes, cuts to the labia, cuts to the arm… Hopefully no one scars too badly haha! Similar to my first ER patient, i reduced many fractures (the worst of which was a 10 year old who had fallen on his outstretched arm and his bones were almost through the skin). I got to do a FAST exam, which is an ultrasound technique to evaluate for internal bleeding. I also got to intubate all of the trauma patients who came into the trauma bays by helicopter. 
Which leads into my two favorite/most interesting cases. 

1. I got to do my first central venous line, which is a fancy word for a huge IV that’s in your neck and gets threaded to your heart… The woman was awake and could feel almost everything because the local anesthetic only works in the skin. After I completed it (successfully! On my first try!), her labs showed she was about to bleed out, meaning the central line I started could’ve killed her if I didn’t do it correctly. All of the doctors were high-fiving me and telling me how gutsy I was…. Truth is, we didn’t have her labs back or we probably wouldn’t have tried the central line! 

2. My other favorite case sounds horrible, and it was. But we got to make a big difference in this man’s life. He was an 85 year old man who had shot himself in the neck in his kitchen, then walked out to his garage where a neighbor saw him fall. EMS showed up thinking he had just fallen and after investigating the scene, realized what had occurred. When we saw him, he was in and out of consciousness & we couldn’t tell from where the bleeding was specifically coming. The trauma anesthesiologist called me to the head of the table and told me to secure the airway and intubate the patient… Did I mention he he shot himself in the neck? IE: he might not even have a THROAT?! Well luckily he did and miraculously had minimal bleeding in his oropharynx (mouth + throat). The intubation was difficult but I was able to get it and help keep him alive. I didn’t see him after they took him back to his emergency surgery, but I heard he did well and was able to go home to his family and was grateful to the team for saving his life after he had tried to end it. 
This rotation had many ups and downs. It was physically one of my more difficult rotations because we were constantly on our feet rushing around and we worked a ton of overnight shifts. Emotionally I was exhausted by this rotation too because of the variety of cases we saw. Our ER would regularly go from empty to full of trauma patients in less than two minutes. We would often have difficult and complex social cases and had to call child protective services several times. We would be frustrated by trying to help someone and realize after hours of coordinating care, they were just there to get prescription drugs. It wasn’t all bad though! I enjoyed most of what I saw and did. One of my patients even told me I was the most beautiful doctor he’d ever seen! All in all, it was a wonderful experience I won’t soon forget.

 

trauma helicopter bringing in a MVA patient

 The month after ER, I went back home to Tulsa, OK for a month long rotation in pediatrics. Since it was for residency, I’m not going to say much about it on here other than I loved the program and my interview went well. My time at home was much too short as usual! Thanks for reading! Stick around to hear about my pediatric plastic surgery rotation! 

wind from the trauma helicopter!

 

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One thought on “Emergency Room 

  1. Yes the ER so exciting…..and OH the slices of life. Iam always so enterrtained by you viewpoint and you choice of words! It is really gratifying to solve the emergent problems. I am amazed at how exciting it is and how tired I am after concentrating and responding for 12 hours on my shifts. While it is happening I am not aware of how much work we are doing. at the end of a busy day I am often surprised at how much we accomplish. It was a treat to spend time with you, come back to Tulsa soon we need happy DOCs. .

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