Well, my first week in the ED (Emergency Department for those of you who haven't heard that term before) passed mostly uneventfully. I was thrown in the middle of a physician group turnover, where the majority of the providers who worked with the residents quit. These were replaced by a managed physician group. So, not only was I learning the ropes, I ended up trying to help teach the new, yet experienced ED docs how to navigate the system. I feel like I'm doing very little each day, even though I'm working 12 hour shifts four or five times a week, because I am only allowed one or two patients at a time. By the end of the first week, I had just barely started getting into interesting stuff.
I love to suture, and I only got to do them on one patient on Friday. It was an interesting story, my first time sewing up someone who'd been attacked with a knife. Then I was able to do an I & D (incision and drainage) on an abscess. I love those, they are very gratifying and gross. I'm a blood and guts kinda girl.
This rotation is not giving me the warm fuzzies that I got from inpatient service. I'm relieved I did not choose to go into emergency medicine as a specialty. I am reaffirmed daily that my attention to detail and concern for the long term are needed in primary care. There are not going to be many long exposees on my inner feelings if the rotation continues this way. However, here are a couple of rants:
1. The emergency department is not your morning after clinic. If you get wasted and have casual relations with who knows who and how many, that is your problem. If you are big enough to do the deed, then you are big enough to deal with the consequences. Here's an idea...if you know you are going to party, PREPARE ahead of time! Use protection, birth control, whatever...better yet, keep your pants on! There is nothing worse than having people bleeding and dying and having heart attacks, and getting interrupted by the young folks asking how much longer until they are going to get their STD checks. Your unfortunate sexual encounter is NOT an emergency. Find a primary care doctor, go to the health department or something. That is not to say a victim of rape is in the same category, don't put me on the cross. That is an emergency for many reasons, and is handled as such. And really...gross. Accidents happen, but c'mon! When you come in monthly for STD treatment, and you know the ED docs by name...enough already.
2. The government did a disservice to the mentally ill. I do not believe in institutionalization of mentally handicapped or psychologically ill people, but institutions have a place. In the eighties, many mental institutions were disbanded and the folks who were not completely catatonic were put out on the streets. This was initially supposed to be a humanitarian gesture, a human rights thing. People were no longer able to put away their kids with Down Syndrome or other mental disabilities like they were something to be hidden away. This is inappropriate use of an institution (there was a time when physicians would tell patients their children had died or would encourage them to put away children born with those problems--a very sad time for the family). However-the result was this: Those with Down's went to live with family or in a group home. Those with PTSD, schizophrenia, bipolar, etc were put out on the street, because when on the right meds, they were functional. Often, these folks don't stay on meds for any number of reasons. Now we have a homeless epidemic...the majority of whom have mental illness. In an effort to self medicate, street drugs and alcohol become addictions, leading to terrible health problems. Now in the 2010s, the ED often becomes the holding facility for suicidal, homicidal, psychotic, lonely people. This is dangerous at times and a burden to say the least. For instance, today in a 28 bed ED, of which only 21 of the beds were available for use, there were as many as eight 1:1 psych patients. 1:1 is where one person watches one person who is a risk to themself or others. This grid lock tied up those beds all day, because on average, in our city, we are short 400 psych beds on a given day.
3. Wear your seatbelt. Most of the worst trauma I see is on those who are ejected from their vehicle in a wreck. Wear.Your.Seatbelt.
YOU ARE READING
Confessions of an Intern
Non-FictionThese are musings of mine, told as I grow through residency. I hope to share a little insight into the making of a doctor, one who still cannot believe she's been blessed with this responsibility.
