Since my last post, I have finished my pediatrics rotation and completed an emergency medicine elective. I know I haven’t written too much about peds, but I had a great time on the block chiefly because a) no one yelled at me for six entire weeks, which is a clinical year record, and b) kids get better, as I mentioned before in It’s Always Turner Syndrome.
I must reiterate that despite this excellent experience, I cannot be a pediatrician. It’s not the patients, or the diseases, or even the parents – it’s the other pediatricians. Everyone is much too happy and peppy for a curmudgeonly, 27-year-old version of Gran Torino-version Clint Eastwood. It is some kind of requirement that everyone on peds walks around all day looking like Enzyte Bob from natural male enhancement commercials.
I am not Enzyte Bob. I am at best a mediocre rank on the happiness spectrum who happens to possess a remarkably crude sense of humor and a bitingly sarcastic wit. This, understandably, does not go over so well with people who derive their principal daily joy from handing out stickers of Dora the Explorer.
Get off my lawn.
Don’t take this as criticism of pediatricians – I loved them, and I loved peds. Seriously. I wish I were nice enough to pull it off as a career, but if we’re being honest someone would accidentally sprinkle ricin on my lunch by the end of my intern year.
One other last thing about peds before talking about emergency medicine. Now that I’ve completed both OBGYN and pediatrics, I can say that babies are awesome except 1) when they first come out as terrifying, mucus-borne Alien monsters, and 2) when they project bodily fluids onto you. All kinds of bodily fluids. Enough said.
Okay. So emergency medicine.
At the end of pediatrics we get a chance to do a 2 week elective in anything we can get into, and mine was emergency medicine. We had a few shifts in the emergency department, but almost every morning started with a lecture from one of the national legends in EM. At the start I intuitively feared this man in the same way that most people intuitively fear bears. By the end, he was my favorite lecturer of the year.
This fine man has many defining features, including:
- An incredibly large moustache that rivals Yosemite Sam’s
- An ironclad requirement that every issue – whether it’s chest pain or headache or shortness of breath – has “FIVE reasons, FIVE causes, and FIVE treatments… FOR EVERYTHING!”
- A catchphrase, which is “GIDDYUP!”
In the EM department’s conference room, there’s a poster of this guy in Barack Obama-style stenciling with the caption GIDDYUP. So yeah, it’s his thing.
Our third lecture from him was on treatment of anaphylaxis. (For the nonmedical, anaphylaxis is fancy useless medical terminology for “allergic reaction to stuff that can kill you.”) He spent a good portion of the lecture describing the formulation, dosage, and administration of epinephrine, while intermittently yelling about his five reasons for things. Often these things had nothing to do with allergic reactions, like “THERE ARE FIVE CAUSES OF ALTERED MENTAL STATUS.”
One student volunteered there were more than five causes of altered mental status. He has not been seen since.
At the end of the epinephrine talk, he asked us to go with him to see what an ampoule of epinephrine actually looked like. We went out onto the floor as he called a nurse over to open the medication cart.
I ended up standing closest to the cart. The nurse looked at me and said, “okay, what do you want?”
I looked at Giddyup. He looked back at me, vague disapproval at my lack of initiative flickering across his face. I am usually okay with disapproval but I kind of want this man to like me, since I might end up working in his ER one day.
“Pull out the 1:1000 epi, please,” I said tentatively.
(There are two formulations: the 1:1000 version is “undiluted” and is used for people who are trying to die of allergies, and a 1:10,000 edition that you use for cardiac patients. Obviously picking the right one is pretty important.)
He pulls out the wrong one, evidently on purpose. “This one?” he says.
“No, that’s the cardiac epi, we need the 1:1000 kind.” The nurse, who was obviously playing along for Giddyup’s benefit, pulled out the correct one. “What’s the dose?” he asked me again.
Why does he keep asking me questions? I started sweating. Ask someone else you jerk. “Draw up point three mLs for a .3mg dosage.” (Before you get excited, we had heard this on repeat for the last hour. It wasn’t a rocket science leap of cognition I was making.)
Out of the corner of my eye I saw motion. I look over to see our lecturer making a rhythmic motion that can only be described as “mimicking riding a mechanical bull” with a huge grin on his face. I looked back at him, confused. This went on for a few seconds (you can imagine how awkward it is to make prolonged eye contact with someone who, for no good reason, is pretending to ride Secretariat).
Eventually he was unable to contain himself any longer and blurted out, “GIDDYUP! Class dismissed.”