December 10, 2009

An Afternoon in the ER

A few weeks ago I shadowed an incredible physician in the ER for an afternoon. I had planned on going for a few hours after class and ended up staying for half of a shift (= 6 hours) because it was fascinating.

For background, I had actually never thought about becoming an ER physician until I started interviewing for medical school. I had been of the opinion that I would be personally frustrated by stabilizing and not treating patients. However my interview at the medical school I currently attend was with an ER physician and I just loved hearing him talk about his work. The biggest thing that struck me was that he said, I am the very last type of physician who says, I will try to help no matter what; no matter who you are, what you have (or don't), if you have insurance, if you speak english, if you live here or are just visiting - I will try to help. And while I think that speaks to the flaws of our medical system, it's also true.

So I arrive in the ER around 2 pm with my stethoscope and lots of questions. Over the course of the time we saw so many patients that there isn't space to recount them all, so I'll just pick two.

The first was a man who came in an ambulance having grand mal seizures and potentially a heart attack. It was the first case where I got to see the ER respond. It was almost like a dance; the physician I shadowed prepared to create an airway down this man's throat, the nurses set up all sorts of medication stations, the charge nurse (the head nurse) coordinated with the paramedics so that when they arrived, they knew exactly which room to come into and what to expect. They cut off his clothes, hooked him up to monitors for his heart, breathing, and blood pressure. Then the physician started talking to him, in between seizures, to check to see if he could be responsive. He grabbed her hand and dug his nails in hard. They got him hooked up to oxygen, made sure there was nothing for him to hit, and started to give him medications to help break his seizure.

The second was an older man who came in with his brother. He was incredibly thin and pale and his brother was scared because he had not wanted to get out of bed that morning or eat anything. The physician I was shadowing asked them about their history and found out that the patient was terminally ill and had spoken with a hospice care worker with whom he (and his brother) had decided that he would be comfortable at home. His brother, it seemed, was rethinking that decision as the patient was getting closer and closer to actually dying. The physician explained what hospice care was and asked the patient if he still wanted to do that. The patient said yes, but his brother begged the physician to admit him to the hospital.

I left the ER, finally, because I had to head to another meeting (and study the rest of the evening) but after being so privileged to be a part of those intimate moments my head was buzzing and I felt like I was floating. I'll be back for sure.

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