My emergency medicine rotation has ended, and all I want to do is go back to the ER.
Actually that’s a lie. All I actually want to do is sit on my couch and do my best Fat Bastard impersonation by watching eight hours of NFL Red Zone. Which, if we are being honest, is exactly what I am going to do. Being between blocks in the third and fourth years is a little bit like getting a 48-hour pass from prison: no responsibilities, no homework, no email if you don’t want it, and nothing to do.
Anyway. I am coping with the loss of my favorite rotation by writing about it.
In case you’ve been away for awhile, here is essentially what I have learned through two years and change of medical school:
- I greatly enjoy doing things;
- I greatly despise standing around and talking about, but not actually doing, things;
- All else follows from 1) and 2).
A cursory review of my last year’s worth of posts will confirm this.
Next week I start my anesthesiology rotation. You may remember “Go To Sleep, Or I Will Put You To Sleep,” where I wrote about a two-week elective on anesthesia. I’ll do a month this time and have a chance to do many more things: intubating, placing lines, administering drugs, and a favorite in anesthesiology, taking breaks.
Anyway. We’ll talk about anesthesia when we get there. In the meantime let me tell you more about how emergency medicine is the greatest.
I go to medical school at an enormous tertiary care medical center serving a geographical area that includes approximately 270 Chipotle locations. It is important to note that a) I spent approximately an hour obtaining this information; and b) it is probably much more than 270 because the number was based on 2013 data.
Anyway. It’s a big hospital. Our emergency room is split into units, with the “A Pod” serving the sickest and most acute patients. All the traumas, heart attacks, strokes, and stuff like that should go to the A Pod. The “B Pod” is a lower-acuity setting and at times resembles the waiting room of a primary care or after hours clinic.
As a med student, because the A Pod has the sickest people we aren’t supposed to see patients on our own and do the whole presentation thing. Sometimes we stitch up lacerations or hold someone’s neck in alignment during a trauma, but in general our job is to shadow.
The B Pod is completely different. There, we operate as the intern. We pick up and see new patients, do our own physicals, present to attending physicians, write our own notes, and put in our own orders. In short, we do things.
Most residents here dislike working the B Pod because they’re training to take care of true emergencies, not to do primary care, which makes sense. As a med student, though, I LOVED the B pod. Not only do I get to do things, I get to do ALL of the things. I get to pretend to be a real doctor, even though the reality of that is still two years and many tests ahead. The best part is that even though the night is dark and full of terrors, because I am still a fake doctor I have zero responsibility.
I was merrily working my way through a list of patients and to-do items – laceration repair, follow up on someone’s chest x-ray, order labs for room 24 – when a patient with a chief complaint of “ALLERGIC REACTION” popped up on the board.
MINE! Allergic reactions in the B pod are usually of the rash/vomiting combination after a new drug, but sometimes a patient starts swelling and they need Things To Be Done, like a dramatic injection of epinephrine into the large muscles of the thigh. And if someThing is going to Need Doing, I will be there.
I’m not saying I was hoping for that, but…
I walked in the room, epinephrine injector held high over my head and a demonic grin on my face (no, not really), to find a middle-aged lady anxiously flipping and highlighting her way through the table of contents of the King James Bible.
This is known as a Positive Bible Sign.
I asked what had happened. Over the next twenty minutes, the patient unleashed a torrent of words in full Faulknerian stream-of-consciousness, relating a tremendously confusing story that encompassed a steroids taper, “hot back pain,” putting in her two weeks’ notice at her stressful job, a tearful interlude about Dairy Queen, and anger at me for keeping her waiting seven minutes. In between breaths, she would intermittently look down and highlight random verses from Revelations.
I spoke zero words during this time. Her daughters, sitting in the corner of the room playing on their phones, seemed unmoved by this soliloquy.
I listened to her heart and lungs and got the hell out of there to present to my attending.
On the way back to where the attendings hang out, the daughter caught me and told me that the “dairy queen thing,” which I did not understand the first time, included the patient attempting to exit their moving Chrysler minivan on the interstate in order to get a chocolate milkshake.
The attending, once I found him, said, “So what’s going on?”
Exuding confidence, I replied, “um.”
After gathering myself a little, I related a story that began, “Ms. M is NOT here for an allergic reaction. She is here with a chief complaint of altered mental status.” I concluded my presentation, which included the phrase “no suicidal ideation, although she did try to self-extricate from a moving vehicle at highway speed to obtain a subjectively mediocre dessert,” with the assessment that my patient was in the middle of an acute manic episode and needed to be hospitalized.
The attending shook his head, apparently not believing me, and went to see the patient. I went back to my to-do list.
Thirty minutes later, the attending reappeared. He looked like a man who had just watched the end of Saving Private Ryan.
“I’m calling Psychiatry,” he said.
Moral of the story: triage notes are not always what they seem. And the B Pod is awesome.