ER Residency: ER "rotator" month

So I'm starting out in the ER. Its a little bit of pressure because I want to be good at everything, and I'm obviously not. That said its only a "rotator" month. So here, they halve the ER and it has 1 upper level and 1 lower level ER intern in each section. The residents who are NOT ER (from psych, internal medicine, OB GYN, etc) are added to one of the halves but are expected to do less. By that I mean carry fewer patients, go slower, and generally ask more questions. They also get reduced hours (they don't work the full 12 hour shifts) and they also only have 16 shifts a month instead of our usual 18.

So as ER interns our first month in the ER (mine just happens to be the first month) we are "rotators" so we can get used to the flow of the ER.  However, we are still on 12 hour shifts and we are still expected to carry more patients than the rotators... about 4 patients at a time.  So we are called "super rotators".... this is all very complicated I know.

Anyhow. My first 4 shifts (all that i've done so far) was a crazy cluster. Its like every patient who comes in here is REALLY REALLY sick.  We are only half thrown the the wolves. We pick up patients and chart and put in our diagnostic orders before

I, as in personally, saw 7 gun shot wounds (GSWs), two of which were life-threatening, bleeding-on the floor, pee-your-pants-cuz-ur-the-doctor-now kinda patients. I had to change my scrub pants twice that night because there was too much blood on my pants to walk around the hospital!! Contrary to popular belief most of the time we leave the bullet in unless its causing problems... I saw 4 septic patients, two of whom I did an internal jugular central line (an IV through the neck which the tube sits in the heart to give certain medications).

I also had a 300lb guy who had headaches, neck pain, and a fever of 103. No nuchal rigidity but luckily I had him walk to the bed from the wheelchair and he was pretty ataxic. So I did my first lumbar puncture. He screamed and legit cried the whole time. It took me about 2 minutes to find the proper spot and I had to get an extra long needle we affectionally call a "harpoon."  But I got it! It was a bloody tap and we ended up diagnosing meningitis.

Another guy came in for a simple headache on and off for the last 2 weeks. He said they were intense pain but lasted only about 5 minutes at a time.  The thing was although his neuro exam was fine, there

was just something off about him. He was having trouble recalling words like "thumb" and seemed to be very distractable, was the text book "inability to concentrate" and so I ordered a CT scan of his head. I had to fight the attending at the time, who was like CT for headaches?? why did you order that? His neuro exam was normal, blah blah blah. Luckily, the scan had already been done by the time he saw I had ordered it.  He had two large masses in his brain, since there was two it was most likely metastasis. And so had to be admitted to try to find the primary cancer. He was close to herniating. Talk about a hell of a first shift!

 They were joking about how I looked like I just got out of high school and I had to tell them he had masses in his brain and likely cancer. It was kinda depressing, yet empowering..... I'm the doctor. And they were looking at me to make the decisions. The attending wasn't there. It was my first solo "bad news" talk.

I also had a patient who came in because he "fell out" which is a phrase they use down here to mean passed out. And hit his face on concrete. He had a really intense nasal dislocation and also had
multiple facial fractures below it. It was crazy. So we had to consult opthomology, plastics, and internal medicine to work up the reason for his passing out. Poor guy. He even let me take a picture because he wanted to see what it looked like. :D

I had another patient who I also thought would be a quick case. Guy came in for back pain, he was a young 30 year old. but the more you talk to him the more symptoms he'd come up with. Problems sleeping and his joints ache and blah blah. Turns out he had osteomyelitis of the spine (bone infection) that was so bad, one of his vertebrae was nothing but pus. Even the surgeons said they couldnt' drain it because then there would be nothing left holding up his spine! So much for simple back pain.

Another one that should have been easy (sensing a theme here?) was cough. Turns out that he coughs while i'm in the room. Didn't sound so bad but there was a bit of blood on the tissue paper. It was hard not to notice. So did just a regular Chest xray.... Then I had to do a CT of chest. Its the biggest cavity of Tuberculosis I have ever seen! Ridiculous! Guess I've officially been exposed to tuberculosis (TB) again!!

I also had to run out to the parking lot twice because I almost delivered a baby there. Too bad the baby was too fast :) Delivered itself. Would have been a great story....