Christmas Break Adventures.

So i get a week and a half off for Christmas. I also got, thanks to my mom's connections, to have lunch with and also shadow a few different ER docs.

At lunch, I learned a bunch of things- things that I want to remember. So I've recorded this for me but take from it what you will. She talked to me about the cons of the ER and the politics of it. This is what I remember.

• if i want to be an attending (teacher) then I have to take a job in it right out of residency- its harder to go backwards than forwards 
• 90% of what she does to pts in the ER doesn't matter, they would be fine without any intervention. Its that 10% that she lives for, less than a patient a shift. You have to be fine with this to go into ER
• Be sure to remember there are multiple kinds of ER docs. private sector gets the $$, urgent care gets the time off, locum tenums gets the stories, and the academic get the insurance benefit and retirement plan. 
• I can specialize later in EMS administration, something an ER doc does on the side very basically free. But it means you're the head of the ambulance company and it might be something fun to do when you're retired (or if you are a part time mom part time doc :)
• Almost all ER doc contracts are for hours spent in the ER per year, not when or how. You can always work 3 months straight and have the next 6 months off-- the question is do you want to?
• Ask about who makes the schedules, how early the schedule comes out and how often you can request time off when you get your first job.
• Live in state where there is Tort reform, especially if you are paying your own malpractice. 
• Its hard to get over being sued, because your confidence decreases. there are no easy answers to getting over this other than avoid being sued as best you can from the start.
• Get a letter from a more established program because that carries more weight than a younger program. Two SLORs are recommended but a SLOR plus a letter from just 1 ER doc looks pretty good. 
• Getting a letter from a charge nurse, especially of ER, is probably the best its gunna get.

Shadowing was good. It was interesting to be at an ER without a residency program. The docs didn't know how to really handle a student and they weren't familiar with how to teach. In the end, I got the impression a few of the docs wanted me to admire their skills more than teach me something. But I did get to see a few good cases over the course of a few hours. One in particular was so good that I had to take pictures of it. It was a bouncer at a bar who tried to break up a fight. The guy got in a good punch and knocked him down and kicked his face. This is what it did to his eye.

And yes, he couldn't see out of his eye, you can see how large the pupil was (we call it a blown pupil since it doesn't respond to light).  We called the opthomologist who refused to get out of bed so eventually we called the plastic surgeons and they tried to repair it as best they could.  Seems like the guy kinda got a little screwed to me... but at least the plastic surgeon cared enough.