Fireworks

I strolled into the first day of work on July 3rd with expectations that I would be a little overwhelmed by everything that was happening. After all, everything would be unfamiliar to me: the docs, the systems, the nurses, the techs, my job as Dr. Bostonian...everything except for the medicine. I dropped my bag off, met the other intern on with me in the lounge and we headed down to get things rolling. Introduced myself to the attending who I had met only briefly before, said hi to the day team of interns and found my resident for the evening.

Within about thirty seconds- Posterior wall MI with cardiac arrest rolls in and the day team hopped onto it. And another 30 seconds later VFib arrest rolls in across the hall...guess I'll hang out and see what needs to get done. We worked on the guy for about half an hour without success. Great...first patient of residency didn't make it...way to start out your career Dr. Bostonian.

Anyway, I saw about 5 other patients (read: slow as molasses). Diagnoses included Anxiety (caused by father's VFib arrest), temporal arteritis (ok...they were sent in by an ophthalmologist with that as #1 in their ddx), painless hematuria (found a simple cyst in the kidney...will follow up), EtOH intoxication (metabolized to freedom) and first trimester bleeding (now with BV!). I made the mistake of stacking up all of my dictations until the end of my shift so my 9 hour shift turned into a 12...especially because I didn't know how to work the damned dictation service and had to re-dictate one patient 4 times.

Second day was July 4, and the temps topped out in the mid 90's with a large festival planned downtown...with explosives everywhere...and alcohol...it could have been a LONG shift, but everyone was still out partying when I walked in mid afternoon. I'll just say that my first case was Peds, involved evidence collection and a lot of paperwork which filled in the otherwise slow afternoon. Then after a few hours devoted to that patient, I was able to re-enter the rising tide of the ED and start pulling my weight. I saw 5 over the final 5 hours of my shift, admitted 3 and signed out nothing. I managed to dictate one of the patients as I went, but the rest were stacked up towards the end of my shift but I still managed to get home about an hour earlier than my first shift.

One interesting patient I had was discharged 2 days prior and had been having nausea/vomiting/abdominal pain without any distention and had popped his trach out with all of the vomiting. He looked sick as stink, and I knew he wasn't going home. While his oral contrast was winding its way through his bowel on his way to a CT for a final diagnostic piece, I called the admitting resident to get things rolling...and found that's a good way to get your head bitten off. Mental note, unless you have the work-up completely done with a billable ICD-9 code and a plan of treatment, don't call the admitting resident...sorry, it's July.