ED summer in review

I've been pretty lazy about blogging lately, mostly due to the pile of good books on my desk, some traveling, and needing to catch up on my summer research project. Not to mention that the the monotony of being a newly minted second year medical student "working" in the ED doesn't exactly make for exciting blogging. As my six weeks in the ED come to a close, I'd like to share a few of the many things that I have learned while either holding up the wall for 6-8 hours of a shift, running around doing scut for the understaffed, overworked nurses or just sitting around thinking about trying to fall asleep after a night shift.

1. I learned nothing in first year of medical school
Seriously. $60,000, hundreds of class hours, hundreds of study hours...and I'm still completely useless. You could drop dead in front of me, and I'd be standing there with my thumbs up my ass. I wouldn't know where to begin beyond what I already know from my long-expired EMT-B certification (ABC's, bleeding=bad, stablized c-spine=good, call paramedics).

Feeling useless is the most frustrating situation that I can be in. Being paid to stand in the corner and observe for the summer is about the equivalent of Chinese Water torture. I can't wait until third year when I can be made to perform useless tasks for nothing more than the benefit of my education...at least I'd be doing SOMETHING. One of my least favorite attendings said that my experiences this summer would be "valuable" in the future because I would be "used to being around very sick people." I contend that (since he dumped me off with the NP in fast track instead of teaching me anything) the past six weeks were pretty close to worthless because I barely know any patholgy/pathophys. I've learned about as much about medicine this summer as a 4 year old learns about zoology from a day at the zoo.

2. Your attending/resident can make or break your learning experience I've had the chance to work with pretty much every attending in the department, as well as a few of the residents and interns rotating through. I loosely define "working with them" as following them around for my shift. The individual responses of the physicians vary between mild annoyance to completely ignoring the fact that I am there. There were 7 of about 15 EM physicians that were willing to acknowledge my presence, and about 3 of those that actually took time to explain ANYTHING that they were doing (the physician who organized the program has yet to acknowledge me). I mean honestly, how long does it take to explain what the lab results indicate as you're typing up your note...30 seconds? 45 seconds? How about explaining what pertinent information you gleaned from the history as we're walking back to the nurses station? I understand you're busy, but treat me like the somewhat intelligent human that I am, not like part of the wall.

To be fair, there are a few of the attendings who are very good about explaining what they are doing, and the tidbits of knowledge they dropped have been extremely helpful in understanding what's happening with patients, why we're using certain treatments over others, etc.

3. Nurses are amazing resources
The nurses in the ED have been wonderfully patient with me. I mean sure, I'm a complete annoyance who barely knows how to stand out of the way, but they figured out that med students (surprise, surprise) learn pretty quickly and come in handy as an extra body for procedures that generally suck. But then there's those times when the floodgates have been opened and there's patients in every stretcher in every room (most afternoons) when I actually get to help out and move the meat along. Yeah, I may be doing scut, but atleast it's something.

4. Night Shifts aren't all that bad
Sure it's dark when you show up at the door of the ED and light when you leave. Sure you know that every normal human being is comfortably nestled in their bed at home asleep, while you're pounding that next cup of coffee. Sure the crazies, the drunks, and the drug seekers are the only people that roll into the waiting room at 2AM...and that lady with poison ivy who's getting really itchy again. But there's a certain cohesiveness of the night staff that I haven't experienced during the day. It seems to come out of the feeling that "this really sucks for all of us, there's no one else who's awake right now so we have no backup...just whoever is in the department and the residents up stairs." That feeling is pretty much all that gets you through the night, especially around 4-5am when you've been awake for about 30 hours and that little forced nap before your shift just didn't cut it. You know it's morning when those urgent Urology and Plastics consults that got called in at 3AM start showing up. There's really no words to describe the feeling that I have when those Ambulance bay slide doors open at 7:30 AM, the sun hits my retinas full force sending pain shooting all the way back into my visual cortex and seeing all of the hundreds of people streaming into work. It feels like "HA, we made it through another night without all of you...good luck with the mess we left behind."

5. Wear you freaking helmet
If I see one more helmetless moron falling off his motorcycle, flipping his ATV while holding his 5 year-old helmetless daughter or riding his bicycle without a helmet that rolls up in the ED with a GCS of 8, I think I'm going to flip. For the love all that is good and holy, wear your frigging helmet. It may not look cool at the time, but it certainly looks better than that depressed skull fracture you're sporting or that fancy respirator that's breathing for you since the blood and edema currently compressing your brain stem is making you unable to sustain your own life.

And while you're at it
, it would be great if you could also not drive into that tree with your minivan full of children after 10 beers, drive your motorcycle like a maniac only to be clipped by that car your just cut off at 70 MPH, and please don't hit pedestrians any more...their bodies aren't really made to stand up to your 25 MPH attempt to nudge them along in the crosswalk. Don't even get me started on power tool safety.

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