Sunday, October 7, 2018

Emergency!

Hello, blog! The time has come again for me to wax lyrical about how quickly the past three months have gone.


This time might be particularly interesting because I have been smitten with what is probably the worst case of pharyngitis in the world, so I am writing from within a weird fever dream-like fog. I have had several fever dreams in the past few days; they were very strange but also very real. I left several messages unanswered for a few hours as a result because it was hard to tell what was real and what wasn't, and I didn't want to be texting someone based on a strange dream I'd had that involved them. Text responsibly, friends!


Anyway, the past three months have not been an easy three months for a number of reasons, none of which I wish to write about. What I do wish to write about is my time on ED, which has actually been pretty great. It was a rotation that had received glowing feedback from most interns before me, so I was quite keen to start. Also, I was glad that we had a pretty good group of interns on the rotation, as it would make for easier shift-swapping and far more enjoyable shifts. It was looking to be a good rotation!


My aim on ED was to see as wide a variety of presentations as possible, as well as to get some procedural skills in. Looking back, I can pretty confidently say I managed to do both these things. I've seen Paeds, O&G, Psych, Gen Surg, all manner of Med, and even Ophthal cases! Trauma, both exciting and unexciting, was a common presentation; I even got to do some suturing, which I was super excited about. The bosses were wonderfully encouraging, talking a few of us through cardioversions and maintaining the airway during these, and letting us take over as they supervised. Towards the end of the rotation, I managed several Cat 2s (which I'd been terrified of doing at the start of the rotation), and was involved in a few resus cases. I think it's the resus cases that I really want to talk about.


It's a well-known fact that every doctor in the hospital sort of hates ED. They're an easy target, really. The jack-of-all-trades ED doctor wouldn't be the best at managing a complex patient before referring them on to the relevant specialty, which is often a cause of disdain from other doctors. There's also the fact that these referrals are being made in the first place, which means more work for the accepting team, and nobody likes being handed more work. People start to see ED as nothing more than a glorified triaging service, which is unfortunate, because they don't see what goes on apart from these referrals. And there is a lot that goes on apart from these referrals.


The most impressive thing has to be resus, or resuscitation. The first time I watched a cardiac arrest resus, I was awestruck, and the feeling has stayed with me since. Good resus cases are a sort of organised chaos, and things run like a well-oiled machine. People are assigned tasks, others stand back until something else needs to be done, and the team leader watches over everything and gives the orders. Airway. Breathing. Circulation. Disability. Exposure. Correct things that need to be corrected. Is the rhythm shockable or non-shockable? Then to rule out the 4Hs and 4Ts - the BSL's been done, so someone run a gas and someone else grab the ultrasound machine to check for tamponade. It's so quick and concise and systematic, and there's an electricity in the air like nothing else I've ever felt. Resus is amazing.


If you think about it, isn't that really what ED is for? Actual emergencies? And if ED handles these things and handles them well, I'd say they were doing a pretty good job. (I don't know. Maybe I'm young and naive and biased, and will change my mind once I become a jaded Med reg. We'll see.)


Of course, while resus is the bread and butter of ED, it is hardly the most common patient presentation. You would think that you'd see many emergent cases in the Emergency Department, but that was very often not the case. Ambulances get called for a variety of non-urgent things, which really gets my goat. One time I had to take deep breaths and calm myself before seeing a patient who had effectively called an ambulance for five hours of diarrhoea. They brought him in because he had a complex medical history which included some bowel problems. It came to light, however, that the reason he had been having diarrhoea was because he had been taking an unreasonable number of laxatives.


Never, ever assume patient intelligence. Ever.


The other thing I learned while on ED is that people like putting things up their butts. We had two such cases while I was there (both sex toys, I think), and the x-rays caused quite a bit of excitement on the floor. The unfortunate ED doctor who took the first case accidentally switched the toy on while attempting to manually remove it; they then gave up and rang the surgeons. It was hilarious, and can you imagine the documentation?! You won't get this anywhere other than ED!


It's been a really good rotation with a really good team, and I'm quite sad to leave. The only thing I didn't enjoy about it was the shift work, but then my next rotation consists of shift work too (boo). I will miss the complete lack of pretentiousness, not having to think about what to wear, the wide variety of patient presentations, the 2am food trolley, and the engaging bosses. Thanks for a great term, ED! Tomorrow, I begin shift work on a medical ward. After three months of scrubs, I can't seem to remember what work-appropriate clinical attire means anymore...but I'm sure I'll figure it out. Come at me, AMU. Last rotation, let's go!

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