ER

I keep having dreams that I'm in the ER rushing to take care of another patient. This has happened to me on other rotations but never to this extent...it's like something out of Inception...in the dream I can't tell it's not reality and I definitely have a physical response to the stress. Regardless, I've enjoyed my month of ER more than I thought I would. Sure it hasn't been as relaxing as I'd hoped...working 15 9 hour shifts in one month doesn't sound too strenuous, but you never stop moving the whole 9 hours and with the constantly changing schedule my body doesn't ever really know what time it is. 6 more shifts to go...

There are good days and bad days...I really like the pretty clear cut diagnoses where if you pick the right study you can verify and then treat a disease. 3 year old with fever of unknown origin...she has a UTI. Guy writhing in pain? Definitely a kidney stone. Guy with a week of fatigue...hmm, kind of a vague complaint, but whoa...turns out his glucose was 1200, hello new onset diabetes. Lady coughing her guts out with a clear pneumonia on chest X-ray. That can be treated, no problem. I also like sewing up lacerations...nice, definitive fix.

The diagnostic mysteries are a little more frustrating because in the ER you only really have one chance. Sure I got to do an LP on a guy who may have been having a subarachnoid hemorrhage, but turns out he wasn't. When patients are having bad abdominal pain it's not terribly satisfying to give them some pain meds, anti-nausea medication, and a liter of fluids, run a few tests then tell them you have no idea why they're in pain and come back if it gets worse. I wish I could pull a Dr. House and come up with some really crazy diagnosis, but the ER is not really the setting for that.

Then there are the patients who have no business being in the ER in the first place . Chronic pain patients, an old lady who had been sitting at home worrying about her blood pressure, a teenage guy who had come to the ER (and called an ambulance!) literally every other day for the past 2 weeks for complaints from impotence to coughing up blood. What are you doing here? The county hospital where I'm doing my rotation has on average a 2-3 hour wait...even at midnight. I think the wait actually goes a long way in cutting down on some of the more pointless visits...at the other hospital where I work in the ER as an extern there's usually no wait at all and then we really see a lot of patients with completely non-emergent complaints.

The ER definitely plays an important role in the healthcare system. Even in our fractured non-system it's good to know that there's a place where anyone can get health care. We've had illegal immigrants getting dialysis and, I'm sure, tons of patients who will never pay their bills. Apparently even with healthcare reform the ER crunch is not going away any time soon. Fair enough. Most patients we refer to physicians for non-urgent follow-up won't be able to get an appointment for 3+ months. Sometimes that's just not good enough...and finding a good solution is rough.

I haven't gotten to work in the Shock/OBS unit yet where they get the critical cases, gun shot wounds, MVAs, heart attacks, etc. After watching 8+ seasons of ER I feel like I'm ready. I can always use a little drama...just no more mass shootings of teenagers downtown please.