Buzz Kill

I reported for duty at 8pm and couldn't find the PA that I was supposed to work with. He is the head PA of the ER and, more importantly, I have a great rapport with him. He told me last week that we would be working together in the Main ER for two nights. It gave me such a sense of relief because this PA teaches me and knows my capabilities. I wouldn't have to try to prove myself.

Wel, he was nowhere to be found tonight. I found his girlfriend (nurse) and she told me he wasn't working until Friday. My mouth dropped open. So, I asked her who was working in his place and she pointed to a woman (approx. 60 y/o) sitting across the desk from us. She was a nurse practitioner.

So, I went over and introduced myself as the PA student that would be working with her tonight. I could tell she was irritated by the simple fact that she had a student...and then doubly irritated when I told her it was my first day in the Main ER. Her lack of enthusiasm for my presence hit a nerve. I wanted to flee.

I stood in the corner for 20 minutes before she fully acknowledged me. Standing in the corner waiting to be acknowledged is a horrible feeling. Then she told me that I could ask the nurses to teach me how to draw blood and put in IV's. So, I told her that wouldn't be necessary since I already knew how to do that. I could see the disappointment in her eyes, I wasn't going to let her pawn me off to the nurses to do scut work all night. I was there to learn medicine...emergency medicine.

So she handed me the chart of her next patient. I took the history and performed the physical. The patient needed an IV and blood cultures. So, I offered to do it. But, the male nurse ignored my offer and went ahead and did the procedure while telling me how much he hated doing bloodwork. So, I told him I would have done it and that I would do the next patient. He ignored me. So, I had to laugh and walk out of the room.

I left the Main ER and went back to fast track. The doc that was a jerk to me on my first day...who became my new best friend last week...was there. He was happy to see me and I told him I was in the Main ER. He laughed and told me that the staff tonight was miserable. I just looked at him and told him that I felt like I was wasting my time. I told him how I was supposed to work with the other PA and he agreed that it would be better if I did work with him. When I told the doc that I was working from 8pm to 8am, he ruffled through some papers in his desk and pulled out the PA's phone number.

He handed me the number and told me to give him a call. I didn't hesitate. I knew I wouldn't make it through til 8am without losing my mind. I knew it would stress me out too much. I didn't feel comfortable in my surroundings and the people I was supposed to work with. I didn't feel safe in my surroundings. I was disoriented and nobody was going to be looking out for me. I was a nuisance. If it had been a day shift, I would have had more energy for the situation. But, it was my very first overnight and I knew it would do more harm than good. And although I'm willing to do what it takes, working an overnight under those circumstances would cause me more harm than good.

And I'm not into harming myself.

I tried to reach the PA a few times and finally reached him at 11pm. I introduced myself as his favorite PA student and he laughed. I explained the situation and how I felt about it and he apologized for mix up. He thought he told me about the schedule change. He told me I could finish out the night and then come in on Friday to work with him. I told him I'd rather leave at that moment and come back to work with him on Friday and Saturday! I was a bit surprised at my gutsy request. But, he took it in stride and gave me permission to leave.

I went back to the Main ER and told the NP that I was leaving. She looked surprised. I explained the scenario and thanked her for her help.

I had some anxiety once I left the hospital. I wasn't sure if my behavior was appropriate or not. I started to doubt my actions. I started to worry about what the NP thought about me. But, I stifled those self-defeating thoughts by reminding myself that I am a teamplayer and have gotten along with every tech, nurse, PA, and doc that I've worked with over the last 6 months!

It's my own responsibility to look out for myself. And for whatever reasons...I wasn't comfortable in that environment and it was my gut feeling that told me to get out.

So, I left. I came home and read my horoscope:

Personalities may clash when no one is willing to take the lead. Be aggressive without being manipulative. Whatever you do, keep it light. Give other people the freedom they want. Unexpected events may change the course of the day dramatically, so don't get upset if things don't go exactly as planned.

I guess the day was supposed to go down like this!

What a buzz kill!

Here We Go...Again!

I'm working my first overnight shift...EVER. I'm really not sure what to expect, mostly because I'm working in the Main ER and not fast track tonight.

Nothing like starting your first Main ER experience in the middle of the night.

I couldn't make this stuff up...even if I tried.

8pm to 8am...here I come.

I hope my brain doesn't fall asleep!

52 hours

I've worked 52 hours in the last 4 days! And of those 52 hours, I can honestly say that 51 of them were spent working. Yup, that's 15 minutes a day...just enough time to shovel a sandwich into my mouth and get back on the floor. I worked two 12 hour days and two 14 hour days.

AND I LOVED EVERY MINUTE OF IT!

What a difference one week makes! Last week was really tough. It's not easy being the newbie and some of the characters I worked with last week treated me pretty poorly. But, I grinned and beared it (although I cursed some of them out under my breathe) and I've gained some "street credibility" this week. I learned how the system works, and it's a terribly disorganized system. Now, the docs, PAs, and nurses smile when they see me coming. I've learned what "not" to do and who to ask when I need help!

Today was the most interesting day of the week. There was a wintery mix of ice and snow yesterday. Today the main ER and the fast track exceeded capacity. There were people waiting in the hallways to be seen.

My shift started at noon. I walked in around 11:45 and it was chaotic. I had a lecture to attend at noon and I had to give a presentation at 1pm. I didn't even take off my coat before a nurse came up to me and told me that one of the docs wanted me to meet him in the main ER. I worked with this doc twice last week and he appreciated my "willingness to learn".

So, I rushed over to the main ER and found him. He told me that he needed to aspirate a knee joint due to a gout attack and wanted to teach me how to do it! I took his request in stride, but inside my head there was a little voice screaming, "YES! He likes me...he really, really, likes me!" I told him about the lecture that was starting in ten minutes and he said he had waited an hour for me to get in and didn't want to wait more than another 30 minutes.

So, I ran over to the lecture center and talked to the chief PA...he excused me from the lecture, but reminded me that I had to present a case at 1pm. So, I ran back over to the main ER and learned how to aspirate the joint. We took out 100cc's worth of gooey, sticky, yellow pus from his knee! It was gross...and pretty difficult to get out with the syringe. The doc let me do everything. He just stood behind my shoulder and coached me.

We finished around 12:45pm and as I was getting ready to leave he told me that he had a patient with a laceration that needed suturing. I really wanted to do it, but I reminded him of my presentation. Again, he told me that he'd wait 30 minutes. So, I ran back down to the lecture center and presented my case. Unfortunately, I had to sit around listen to the other students present their cases (5 in total). It took about 45 minutes. The rest of the students were going to the cafeteria, but I ran back to the ER to see if the doc waited.

And the doc did wait for me.

I was psyched. He told what supplies to get and where the patient was located. So, I got all the stuff and went in to meet the patient. Now, I expected that the laceration was going to be on the patient's leg or arm. I expected it to be in a place where the patient wouldn't really be concerned about a scar...they wouldn't be concerned if I accidentally botched it up.

When I walked into the room, I noticed a 55 year old male sleeping on his bed with a laceration to his FOREHEAD! He was hooked up to all kind of monitors (that kept beeping!). I had to laugh. This was insane. I had thrown a couple of sutures a couple of days ago on a finger. The PA started the suturing and he let me throw in a couple next to his.

I set up the materials at his bedside and went back to see the doc. He looked at me and said, "You're done already?" I looked at him like he was nuts! But, he was serious! He told me that I didn't have to wait for him and that's when I told him that I would be more comfortable if he came in and coached me in the beginning. I knew I would be able to get through it alone, but at this stage, I want all the coaching I can get.

So, he watched me prep the patient, set up the sterile field and throw the first suture. He shared some of his suturing "secrets" with me and left me to do the rest on my own. The patient needed 8 stitches and it took me about 45 minutes. It only would have taken the doc 15 minutes (max) to get it all done!

The patient knew I was a student and was fully aware that the doc was coaching me. The patient was really nice and had a great sense of humor about the experience. I was the one that was concerned by the fact that I was stitching his face...but the patient didn't seem to mind. Usually people want plastic surgeons for their faces!

I chatted with the patient during the procedure and built up a good rapport with him. When I finished suturing, I went to get the doc to show him my work. He asked me how it went and I told him, "I did the best I could." He smiled.

As we walked over to the patient I started to wonder if I should be nervous about the doc's assessment of my work. But, I really felt deep down that I did the absolute best job I could. Considering I had no idea what I was doing last week and the fact that I practiced on pig's feet this weekend...and I threw 2 stiches on a finger under intense supervision two days ago.

Did I think I was ready to sew up a face laceration?

Absolutely not! But, I felt comfortable after he coached me through the first suture and that's why I went ahead with it.

The doc got up real close to the wound. As he was inspecting it, the patient remarked, "She did a great job, doc!" All three of us started laughing...of course the patient had no idea what his head looked like. There were no mirrors anywhere near him!

The doc looked at the wound, looked at me, then looked at the wound again. That's when I started to get nervous! But, then he gave me a wink and said, "Good job...dress the wound and meet me at the nurse's station."

I was still a bit nervous about what he really thought. But when I met him at the nurse's station he smiled, thanked me and said, "I knew you were out of your comfort zone, but I also knew you could handle it."

I smiled and let out a big sigh of relief.

I thanked him for the opportunity and headed back to Fast Track.

I still had 10 hours to go.

"I get it, doc!"

I worked with the same Doc and PA as I did on my first day. The same guys that got me so frustrated that I broke out in a blotchy rash over my chest and neck. The same guys that spoke to me like I was intellectually challenged. The same guys that rolled their eyes at me and made faces behind my back.

Yeah, those guys.

One week later and I find myself sitting down and eating dinner with "those" guys. A dinner that the Doc paid for, no less. A dinner that allowed me the opportunity to realize that these guys are human and aren't so bad afterall.

The Doc was the guy that really irritated me last week. And he knew it. He remembered it. And, as I suspected, he seemed to enjoy it.

He reminded me of some of my bloopers on my first day and I started to laugh. I had to remind him that it was my first day...and he genuinely seemed surprise. We both kind of looked at each other like, "Are you kidding me?"

So, he didn't know that my first day meeting him was my actual first day in emergency medicine. He's the Chief Attending at a different hospital and comes in to "moonlight". He then began to reminisce about his days as a resident. Turns out he was cursed at and belittled on a regular basis for 3 years.

I couldn't help but blurt out, "Oh, so that explains the way you treated me last week!"

Luckily, he laughed.

But there was a lesson to be learned. And here it is: "Although it was horrible to be humiliated like that during my residency, I know that there isn't anything that anybody can say to me that will get me upset. Unless someone threatens me with bodily harm, there isn't anything that will make me lose my temper, my focus, or my control. Looking back now, I realize that all of that was part of the training. And that's why I'm an ER doctor. I can handle it."

I made eye contact with him, nodded and said, "I get it, doc."

I get it.

Lesson learned.

Miss Piggy

Today was better...much, much, better.

The 12 hours flew by and I only sat down for "maybe" ten minutes to eat a sandwich. It was busy. There were some interesting cases and I did a lot of procedures.

I'm glad I spent my Saturday night suturing piggy feet because I sutured an arm and a finger today! I did the digital nerve block. Splinted a couple of hands and I also inserted my very first IV...all by myself. Doesn't sound like much...but it's thrilling! I'm a bit more independent today than I was a few days ago and I'm embracing the transformation.

I'm also more comfortable in my surroundings. It's a disorganized and chaotic place and severely understaffed. We worked without a nurse today. But today's staff took it in stride. Nobody stood around pointing fingers, everybody just worked. And the day went by smoothly.

I'm actually looking forward to tomorrow.

Tomorrow I'm working with the same two guys I worked with my first day.

Let the fun begin!

Saturday Night

We spent one day learning how to suture last June. I watched docs and PAs suture last week and I want to get in on the action this week. So, I went to my local grocery store and bought pig's feet.

Yup, pig's feet.

You know your social life has hit an all-time new low when you spend your Saturday night suturing a pig's foot!

But, I feel I'm ready for the next stab wound that comes my way! So, it was worth it!

EMED

Despite my previous entries, I do enjoy Emergency Medicine. I just don't enjoy the hours. It's kind of strange to me. We sit around waiting for something bad to happen to people! Isn't that strange?

I'm working in the Fast Track area for the next 2 weeks and then I go down to the Main ER. I see a lot of things that I saw in primary care. Flu, strep throat, gastroenteritis, pink eye, and there are a ton of motor vehicle accidents (MVA). Again, it's not the main ER so people aren't convulsing on stretchers like on the TV show. It's not that exciting.

There's also a lot of drama at this place. They're understaffed and overworked. Most of the docs, PAs and nurses are cranky. I listen to a lot of whining. That's when I go into the corner and take out a textbook and read. Most of the time I'm tired, so I just look like I'm reading. I like having a schedule. I like having "me" time. I don't have that at this place. There is NO lunch time. Everyone eats their lunch right there in the room.

This is my fifth rotation and I'm ready for more independence. I'm ready for more responsibility. Every five weeks I start over at square one. I've had someone take me under their wing the last 3 rotations. That hasn't happened yet. I'm constantly working with a new doc or PA. I'm constantly in the spotlight. I'm constantly being watched and critiqued. I'm always the new girl. And my colleagues know that in 5 weeks I'm out of there and a new student will replace me.

I imagine its tiring to train students month after month.

Just as it's tiring for a student to train month after month.

6 months, 6 days until the last day of rotations!

Days 2 &3

My second and third day in the ER were much better than my first. Mostly because I'm working with a different doc and PA. I'm working in the Fast Track area for the first two weeks and then I move on to the Main ER. When I showed up at noon, only the doc was there. I introduced myself and hoped for the best.

He immediately began to pimp me. He threw several different scenarios at me and wanted me to come up with differential diagnoses (ddx) for each scenario. He told me that at my level of education, I should be able to come up with 5 ddx for each scenario. I struggled on the first few and he kept telling me to THINK, THINK, THINK. For some reason, when he said that to me, things started to click.

If anything, I know that I can T-H-I-N-K! In fact, I think too much most of the time. The more he pimped me, the more in tune I became to his thought process. When I didn't know an answer, I told him, "I don't know." The first time I said that I didn't know the answer, he had a look of surprise on his face. I immediately thought to myself that the answer must be easy and that I must be stupid for not knowing it. Why else would the doc have that look of surprise on his face?

Well, he was surprised by my "honesty and ability to admit that I didn't know an answer." I kind of gave him a half-smile, because I honestly don't understand how or why a student would try to outsmart an experienced doc or PA. It just doesn't make sense to me.

Within a few hours, the doc began to ask me questions about my past education and work experience. He seemed impressed by the paths that I chose. When the PA came in a few hours later, the doc said, "we finally have a student that knows how to THINK!"

12 hours later, at midnight, the doc came over and thanked me for my help. He told me that it was "refreshing" working with me and that he looked forward to working with me the next day.

When I walked in at noon today, he greeted me with a big smile and seemed genuinely happy to see me. This doc gave me a chance to prove myself whereas the other doc, from my first day, did not.

I've gained some confidence. I've learned some procedures. And I'm ready to prove to the original doc that T-rex has a brain...and knows how to THINK!

Unfortunately, I'm working with a different doc and PA tomorrow.

It's a never ending cycle...no wonder I'm exhausted!

ER

My hours?

This week: noon to midnight x 4days.
Next week: 8 PM to 8 AM x 4 days.

My first patient yesterday?

17 year old male with two stab wounds. He went to school and got stabbed in the arm and the leg by a random kid.

I wonder why I don't want to go back today?!?!

Perhaps the nursing home wasn't such a bad gig?

;)

EMED

My first day in the emergency room lasted 14 hours.

I didn't like the way I was treated by the PA or the Dr.

Both of whom were MALES and underestimated my abilities.

Both of whom tried their best to make me look like a fool.

I know they smirked when my back was turned.

They got off on the power trip.

Now that I know what to expect, tomorrow will be a better day.

T-rex will show up and I'll be the one smirking.

Bring it on, boys.

Game on.