Epic ER Firsts

This week has been epic in so many little ways. For starters, last weekend I spent about 20 hours training a group of folks (one of my income-generating ‘jobs’ that helps pay tuition). Then I moved – that major downsizing  wise move that will make focus on studying simpler but left me with aching muscles I forgot I had. Add in a few other life things and I’ve had a week of major sleep-deprivation.

Yet I just arrived home from my second ER shift of the week, feeling completely energized and just downright happy.

A couple of “firsts” merit mention.

Tuesday was a crazy-busy night in the ER. Was it a full moon or something? A woman with sky-high blood sugar who didn’t know she was diabetic. Drug addicts and anxiety attacks. A man who had been run over by a car (really!) and a probable stroke.

Then there was the young woman who thought she was pregnant, and complained of symptoms of a vaginal infection.

As I took up my usual stance in the corner, the nurse looked at me, looked at my mentor, and said, “How about the med student does the pelvic exam? You’ve gotta start somewhere right?”

I nearly hugged her. Then nearly had my own panic moment.

But its funny how years of being on the receiving end made it simple, especially with my mentor walking me through. There’s something magical and awe-inspiring to me about the human body, and about women’s bodies in particular. One human being growing inside of another – wow! I’ll never tire of this experience.

Fast forward to today. Another crazy-busy night in the ER with a steady stream of broken bones, chest pain, tummy bugs, and babies and elderly folks with health issues. It was nearly end of shift and my mentor was headed to the back to work on charting when Dr. U stopped me. “How are your suturing skills?”

Oh geez. Without even thinking I said, “I’ve never done it”.

And with his typical cheeky grin, he answered, “No time like the present!”

I was even more nervous as we walked into the exam room and Dr. U explained to the patient I’d be stitching him up. This young man had a few pretty deep gashes on his right hand from holding a glass when it broke, and was obviously quite uncomfortable.

Dr. U placed the first stitch and talked through each step, then handed the needle to me.

Eeek!

And, it was so much easier than I imagined it would be. Maybe because I’ve spent so many years hand sewing. Maybe because I paid such close attention to how Dr. U worked.

Stitches neatly placed, a fist-bump with Dr. U, and a super helpful diagram from my mentor Dr. J showing me how to determine the width and depth of needed stitches, and I’m hooked.

I will never tire of the variety, moments of intensity, even the mundane and downright annoying parts of working an ER. But this week, I catalog two more “firsts” that help solidify my dedication to becoming an emergency physician. I will never tire of doing “emergency” pelvic exams, placing stitches, cleaning wounds and splinting broken bones. I’ll also never tire of reassuring new moms and dads that their baby’s diaper rash is typical and easily treated, and calming the elderly patient who’s afraid of needed treatment and forgets my explanation before its complete.

Now, to sleep, and dream of growing up to be an emergency medicine doc one day. Tomorrow is a heavy study day, and I’m looking forward to it.

Its a Blue Baby!

Squeezed between intense study sessions, the very best part of my medical education continues to be the clinical hours spent learning and doing in the Emergency Department. Its not the adrenaline thing, although some folks insist that’s why I love ER. But what I truly embrace about it is the unpredictability, the chance to see something new constantly.

Last night was no different.

We were a little busy. Soon after my shift began, both docs suggested I go do an exam in Room Two where there was a baby brought in for “possible bruising”.

My heart beat faster – after all, its not often they send me in alone first and tell me to practice doing a full exam. At the same time, I was a little worried. Without even seeing the patient, my mind immediately skipped to possible abuse issues, playing through scenarios in my head and wondering why the docs chose this particular patient for me.

Determined to practice compassion while doing a thorough exam, I knocked on the door and introduced myself.

Hi, I’m Student Doctor J, I’ll be doing an exam and then my supervisor will need to come see you as well. So tell me what brings you in tonight…

Baby was dressed in just a diaper as dad tried to explain to me how he had been born with a little mark on his back, but it continued to spread. Now the marks covered baby’s back and went across both shoulders. Not a rash, not the sort of bruises I’d ever seen before. But marks that were kinda bluish. I continued to examine baby hoping I wasn’t missing something, and more convinced as I went along that this really wasn’t bruises and we didn’t need to be concerned about abuse.

I’d never seen anything like it.

Thorough exam complete on an otherwise healthy baby boy, and after learning that dad really wanted some simple blood test to tell him what this was and if his child would be okay, I went back to report what I knew.

Which wasn’t much. Often, when I see something for the first time, I feel completely tongue-tied trying to explain it and last night was no different. Then my attending and I got to do a little research to figure out what this was as he didn’t immediately know either (which perversely made me feel a little better).

Aha! Now I know what congenital dermal melanocytosis looks like! More prevalent among those from Asian (this baby) and African American decent, its an issue where melanocytes are trapped in the lower part of the dermal layer during embryonic development. Its harmless, and most often completely resolves by 3-5 years. And even if the marks remain throughout life, there’s no report of any adverse affect. Parents can be understandably worried when they see those funny looking blue marks, but clinicians need to be aware of the condition in order to avoid concerns about abuse.

Last night, between the inevitable colds and chest pain and panic attacks, I learned about a new condition that I’ll now always remember. And that little bit of researching and reassuring reminded me once again why I positively love medicine in general, and the ER in particular.

Now back to the books; its a Review day, and I’m getting an early start with the endless q-bank questions about glycogen storage diseases, pharm basics, and opportunistic infections. And I’m finding the joy in Review that comes from realizing I actually do remember details of what I first learned many months ago!

How Badly Do You Want It?

I remember being an undergrad and moving back home to save on expenses. Not exactly what I was expecting to be doing when in my 40s, that’s for sure! But I discovered I was willing to do what it took to do well in all those crazy pre-med classes I was completely unprepared for, and a great deal of that “doing well” simply required lots and lots of time. Living at home allowed me to focus exclusively on my studies.

Fast forward a few years, and I’m once again needing to make an adjustment. Sadly, the intervening years brought a house fire that completely destroyed my family’s home, so that’s no longer an option. So I’ve been snooping around looking for a much smaller place that will accommodate me, an adult child, and three German Shepherd dogs.

Its a dream-switch that is a bit uncomfortable actually. Rather than building always toward home ownership again (following divorce and life-stuff), in some ways I’m going backwards in order to go forwards.

Because I want medicine more than anything.

When you’re passionate about a goal, you’re willing to do absolutely whatever it takes. In my case, I have the amazing privilege of attending a medical school that doesn’t allow me to go into debt; that means I have a monthly payment on top of living expenses. So stress-reduction means limiting the expenses I can control by seriously downsizing. And quite honestly, once the decision was made, a whole heap of angst was lifted off my shoulders.

Do you have a thing you’re willing to pursue no matter what? Have you chosen to make sacrifices in the pursuit of that goal? I’m discovering that those sacrifices are nothing compared to the gift of being able to walk boldly forward, knowing that this is another big step in the right direction.

Now, back to the books!