I have to admit, I had NO time during my emergency medicine rotation to blog. Typically I worked 50-60 hours a week, with 1 or 2 days off a week (which were spent packing, moving boxes, charting, and studying). My schedule varied each week. Shifts were 10-12 hours starting at 6am, 7am, 11am, or 3pm. I did get lucky and managed to not get scheduled for any overnight shifts (7pm-7am). Now that my emergency medicine rotation is over and I am fully moved into my new place, I have some spare time! More details to come about my experiences there, but I wanted to give you a little peek into how my days went. Of course, in the ER every day and every patient is different, but here is how a typical day went for a 7 am shift:
5:30 – Alarm starts going off, and I actually only hit snooze once (which is big for me). Knowing that I get to go in to an ER shift rather than sit in class all day is some decent
motivation to get me moving.
5:47 – Take the dogs for a quick walk. They will be home alone for a long while today.
6:02 – On the road with a large iced coffee in hand and it’s still completely dark outside. The hospital I am working in for this rotation is about 45 minutes away. I debate listening to a medical podcast in the car, but decide on some music instead. I’m not typically a morning person, so I am glad for the longer drive to have some time to perk up. I eat a spinach wrap from Starbucks for breakfast because people who are not morning people are also not wake-up-early-to-make-breakfast people.
6:50 – Arrive at the hospital, chug the rest of my coffee, and park. I check in with the doctor I am scheduled with, knowing they may or may not feel like having a student. I get lucky and am with one of my favorite doctors who seems to enjoy teaching. I also let the other docs and PA/NPs know that I am there today in case they have any cool cases or procedures for me to do.
7:22 – I get called to the express area of the emergency department to sew up a laceration. I have done a few so far and am feeling pretty comfortable doing the anesthetization and sutures by myself. As I’m carefully and meticulously approximating the pieces of skin, I wonder to myself “how the hell am I going to do this to a screaming pediatric patient?”
8:02 – After the doctor checks over my work quickly and gives me the metaphorical thumbs up (high five, self!), I am on to the next patient. Someone with chest pain and a history of multi-vessel occlusion.
10:36 – The morning goes on with mostly chest pain, abdominal pain, and fall as chief complaints. I get to assist with a central line placement. The ambulances keep rolling in in a steady stream. I hear the “we must be giving something away for free today” joke at least twice.
13:45 – Before I know it, my stomach is rumbling and I realize its way past lunch time. The providers don’t ever take a real lunch break. It’s more like running to the cafeteria for 5 minutes in between patients. Today the food actually looks pretty good, but it wouldn’t have mattered anyway because I am famished at this point. I shovel in a few bites and head back to the ER. Being away for too long makes me feel like I’m missing something cool. As I am walking back I pass by one of the physicians I worked with the previous day who tells me that they had to preform a cricothyrotomy after I left last night. (DAMN!!) I can’t believe I missed that. See what I mean?? The minute I leave something good happens.
15:07 – The afternoon slows down a little so I offer to help some of the nurses. I do a foley catheter on a patient. I hear the EMS radio go off at the nurse’s station and try to listen through the curtain. Sounds like a code coming in. I feel a wave of excitement come over me. The best part about the emergency room is the things that are actually emergent.
15:22 – EMS roll in with an elderly patient who was found down for an unknown amount of time by a family member. He was on the automatic chest compression device. They transfer him into the hospital bed and everyone goes into action. It reminds me of a swarm of bees around a beehive. It looks like chaos from the outside, but everyone has a job and they don’t really discuss it, they just do it. I’m feeling extra brave and jump in to do chest compressions. The patient was pretty frail and I grimace as I feel the already broken ribs shifting under my palm. The paramedic notices and says “If you don’t feel them crunching, you’re not doing it right!”. It is true though that it takes a lot of force to do a successful chest compression, and ribs are often broken in the process. The patient never regains a pulse and is pronounced dead.
16:32 – The respiratory therapist shows me how to stick an artery to draw an arterial blood gas. I get it on the first try, but only because the patient was young, healthy, and had a huge bounding pulse.
17:52 – My attending doctor tells me I can go home if I want to, but I decide to stick around for the full 12 hours for fear of missing out.
18:43 – I attempt to obtain a history and physical on combative psych patient, and end up dodging some flying spit. On that note, I think I actually will call it a day.
19:03 – I walk out the big double doors heading to my car. The lobby had tons of people waiting; the next shift is in for a long night. I get to my car and feel simultaneously exhausted and wired. Today was a good day. I only got pimped on one question: what is the antidote for a benzodiazepine overdose. The answer: Flumazenil (Ugh, why couldn’t I remember that?). I spend the drive home zoned out thinking about everything that I saw and learned today. I want to get home and write it all down so I don’t forget anything.
19:45 – The good thing about staying an extra couple of hours is I missed rush hour, and get home in a decent amount of time. I take my poor dogs for a walk. Thankfully my friend was able to let them out for a quick break after she got off, so they weren’t alone for a full 14 hours.
20:12 – I strip before I touch anything in the house and shower. I’m pretty sure I have some kind of bodily fluid on my scrubs somewhere.
21:53 – By the time I shower, feed the dogs, eat, and clean up a little (a very little), its already almost bed time again. I pull out my computer to try to take some notes and debrief myself from the day, but as soon as I sit down the wave of sleepiness hits me. I put off charting for the 11th night in a row . . . I know this will catch up to me at the end of the rotation but I am just too exhausted by the time I get home. I watch TV for an hour and don’t even pay attention to the show that’s on.
23:01 – I wonder how its already almost midnight and crawl into bed. I need at minimum 6 hours of sleep to be a functioning human, 8 hours to be a somewhat pleasant functioning human. I count down the hours of sleep I can get like I always do. Six and a half. I guess I’ll take it. I almost fall asleep before setting my alarm, and doze off immediately. All night long I dream I’m in a never-ending code and I try to get to the computer to finish charting but I can’t. When the alarm clock goes off again in the morning I have a few seconds of “Ugh please just let me sleep until noon”. Then I realize I get to go back to the ER and do it all over again. Maybe I’ll get to intubate today? I crawl out of bed and feel very thankful I get to go back for more.