First EM rotation as a real doctor, mission accomplished

Wow, what can I say. So much has happened and so many crazy cases that you will find it difficult to believe. I was in a inner city poor demographic emergency department for 1 month. This ED is so busy and understaffed that it feels like the kind of training that the older physicians speak about so proudly, "When I was a resident I was just thrown in the fire and had to sink or swim ....."

Many of the patients were very sick and presenting late in the course of their illnesses. Many of my shifts were so faced pace that I never even paused to go to the bathroom for 12 hours. This hospital is an amazing place to train as a resident. You see it all and do it all. You definitely get your hands dirty. I learned a tremendous amount and became much more comfortable with several of the core procedures that every EM physician needs to perfect.

I intubated several patients, which is the process of placing a tube into a patient's trachea and then connecting them to a ventilator to breath for them. In the ED this procedure is often done emergently without a lot of time. I ran some codes (resuscitations) on patients found down. A couple we brought back and a couple we lost and I declared the time of death after all efforts were exhausted. I had to talk with the families about their loved one who did not make it.

The worst of these was a code I ran on a patient who was in town with his family for a family reunion. He was relatively young and healthy and while at a restaurant he had a myocardial infarction and came to us in the ED flat lined. We worked on him for nearly an hour. He was the father / grandpa of the family and the entire family was in town on vacation and this was completely unexpected as he was in good health. Needless to say the family was devastated. It was a tough conversation talking with the family. The crazy thing about the ED is that I still had several other acutely ill patients that needed to be seen. I finished the code and talked with the family and had to move on to my other patients.

I had a pregnant patient that was shot in the back. Gun shot wound in a pregnant woman. I had to use the ultrasound to assess her and the baby. Fortunately for both the bullet missed the vital structures of the mother and the fetus. I had multiple lacerations, stab wounds that I had to repair. I had septic nursing home patients, drug overdoses, suicide attempts, heart attacks, asthma attacks leading to complete respiratory failure, brain bleeds, traumas, kidney stones, miscarriages, rape victims, GI bleeds. The list goes on and on. I could not believe the high volume and acuity of the patients.

This rotation kept me on my toes and allowed me to get better at several procedures like lumbar punctures (spinal tap), central lines, suturing, intubations, joint aspirations, procedural sedation, resuscitations, pelvic exams and many others. I loved it and never knew what was going to come through the door. There were times when you felt stretched thin and that can be anxiety producing but it is all part of the training process. A good ED physician has to be able to manage multiple sick patients at the same time and remain calm, cool and collective.

No wonder it takes several years but I am starting to feel like a real doctor.