Farewell, Emergency Medicine

I just finished my last shift of my Emergency Care clerkship, and I have to say that I'm sad to see this rotation end. I've had a blast these past two weeks, thanks to a couple rock star residents who provided a great hands-on educational experience.

Among the procedures that stand out in my mind: performing a lumbar puncture (champagne tap), draining a perianal abscess, suturing a few lacerations, and helping to set a dislocated shoulder and hip.

For as much fun as I've had on this rotation, it's important to keep in mind that my Emergency Medicine experience as a third-year medical student is not very representative of the daily routine of an Emergency Medicine resident or attending. All of my shifts were from 12n-8p, whereas residents and attendings work plenty of overnight shifts. Most of the patients I saw over the past two weeks were cherry-picked specifically because they were interesting and had educational value, whereas Emergency Medicine in general is mostly a bunch of chest pain and belly pain with some altered mental status mixed in. I only saw a few patients over the course of an 8 hour shift, whereas attendings see on the order of two dozen patients in a shift.

Keeping all this in mind, and despite some of its drawbacks, Emergency Medicine is still on The List.

Emergency medicine teaching service

The Emergency Care clerkship at University has a dedicated teaching service. What that means, practically, is that an attending physician and two residents are there with the express purpose of teaching third-year medical students. The attendings rotate daily, but the two residents stick with the teaching service for the whole two weeks, making for some much-appreciated continuity.

The teaching service sees different patients from the rest of the department, usually picked for educational value. The pace is much slower, too, with time specifically allotted for rounds, which just consists of sitting in a conference room or outside in the courtyard, presenting a patient to the group, and discussing pertinent teaching points that the patient raised. It's ironically a very relaxed learning environment.

Pros and cons of emergency medicine

Pros:

• I like fixing acute problems and seeing immediate results.
• The idea has always appealed to me of being a doctor who can ring the call button when the flight attendants ask if there's a doctor on board.
• I like the fast-paced ADHD environment.
• I like doing procedures.
• I get to wear pajamas (scrubs) to work everyday.
• I would be doing shift work, which would allow for a life outside of medicine.

Cons:

• I don't like dealing with the drunks and drug addicts; I can easily see myself getting disheartened by humanity at its worst.
• I've already decided that I don't want to do primary care, but too many people use the Emergency Department as their primary care physician.
• As a resident and attending, I would have to work a lot of overnight shifts. I can handle disruptions to my circadian rhythm, but I don't like it.
• I value the long-term physician-patient relationship, which Emergency Medicine lacks (except for the frequent flyers).

Mock terror attack: Operation Mountain Guardian

Denver Metro and Front Range first-responders held a drill today simulating a terrorist attack. I don't really know many details, aside from what's included in this Denver Post article, but I do know that the University of Colorado Hospital participated in the drill, receiving the "wounded," which consisted of actors and actresses as well as dummies. Being in the Emergency Department, I became an accidental participant. The idea was to test the capacity of the ED to handle multiple seriously injured patients at once.

Contrary to what would happen in real life, the attending physicians were facilitating the exercise with the senior residents at the heads of the beds and the medical students assisting. I put a tourniquet on the stump of a dummy's severed arm and bagged another dummy patient; my classmate did CPR and successfully "revived" another dummy patient.

This was a fun exercise and interesting in terms of putting into perspective the role of the ED within the larger first-responder infrastructure.

Denver Paramedics ride-along

I wish that I could say that today's ride-along with Denver Paramedics was action-packed, but it wasn't. Over a 10-hour shift, we had a grand total of three calls: a Denver CARES patient in alcohol withdrawal, a minor fender-bender with no injuries, and a dialysis patient needing transport. Pure bad luck, a sleepy day in Denver.

This was a very similar pre-hospital experience as the ride-along I did during my first year as an elective, except this time it was a requirement for the Emergency Care clerkship. I think future students would have more luck scoring an exciting shift if it were scheduled for a Friday or Saturday night.

Emergency medicine

I start my Emergency Medicine clerkship at University tomorrow morning. It's only a two-week clerkship, graded pass/fail. The best part is that I've already been working at the University emergency department for the past year-and-a-half with my Foundations of Doctoring preceptor. That means I already know where everything is, how to use their computer system, and I already know most of the attendings and residents and nurses. This will be a welcome change, starting a new clerkship with absolutely no learning curve.

Also, all of my shifts except for one are from 12pm-8pm with no rounds and no pre-rounds. This is quite a change from the 5am mornings I have gotten used to over the past several months.