Im winding up my time in the ED. Its been a love/hate experience.
You get to be largely independent, someone comes in and after an hour or so you have worked out whats wrong with them (usually), started treatment, got them admitted (or set up plans for discharge) and got the plan and story for the admitting team. As a (very) junior doctor, there's not many opportunities to have that much control and responsibility.
When it all goes well, and you have this neat little package ready to be sent off, its a hell of a good feeling of competence, accomplishment and relief.
When you have NFI WTF is going on, or the patient is 'difficult' its a nightmare. There was one day I had 5 of these 'difficult' patients in a row. I nearly walked out. The next day I had a beautiful run. They may have been very sick patients (2 ended up in ICU and another died a week later) but we did a good job of identifying issues and starting a plan to sort them. Compared to the relatively mundane activity of the wards, this sort of stuff makes me think I might have made the right choice to forgo a 'life'.
Interesting things I came across worth a mention:
Aerosol Can up a blokes backside. (Lynx deodorant for those interested)
Burns to 80% of a chap after "cooking fish, on the BBQ, with metho"
A waiting room of completely fucking mad patients (as in 10 psych cases) when it was a full moon. (no lie!)
Dislocated shoulders (pop)
Being asked, can you take this patient? they are quite ill and complex, but you're not an idiot so you can manage it (apparently thats a complement???)
Being in ED for 17 hours because 4 doctors (out of 7) Called in sick and almost telling the wrong patient she had a heart attack.
Hearing the medical director of ED (as in, the head doctor) call the administration a "pack of fucking fuckwit cunts who can go fuck themselves with the fucking bullshit they fuck the patient with" in a phone call to administration.
My very own 'house' moment. Lady with vommiting resistant to every medication, no significant medical history but significant use of pot. Other intern couldnt work it out.
I asked 'had they run out of hot water?'
Other intern asked, what relevance had that got?
We went and asked. She had.
Other intern, and patient is wondering how on earth I could have known that.
Its because the patient had "cyclical cannabinoid hyperemesis" which is nausea and vommiting caused by chronic cannabis use, which is strangely relieved by hot showers! Patients present when they run out of hot water.....
BOOYAA!
(course I had seen it the week before and had NFI what it was either first time I saw it! but hey, no-one needs to know that)
Of course I had a few fuckups. No-one died, nothing serious, but not brilliant stuff. First one was not realising the girl in front of me didnt get the bump on the head from falling over while drunk, but rather from her boyfriend abusing her. Second was telling the mother of a 6 month old "we dont need to take blood, you should be out of here in an hour" then having to backtrack...badly.
All in all, It wasnt too bad. Im kinda looking forward to doing it again. Having to work the last 6 motherfuckin weekends though, is fucking fucked.
You get to be largely independent, someone comes in and after an hour or so you have worked out whats wrong with them (usually), started treatment, got them admitted (or set up plans for discharge) and got the plan and story for the admitting team. As a (very) junior doctor, there's not many opportunities to have that much control and responsibility.
When it all goes well, and you have this neat little package ready to be sent off, its a hell of a good feeling of competence, accomplishment and relief.
When you have NFI WTF is going on, or the patient is 'difficult' its a nightmare. There was one day I had 5 of these 'difficult' patients in a row. I nearly walked out. The next day I had a beautiful run. They may have been very sick patients (2 ended up in ICU and another died a week later) but we did a good job of identifying issues and starting a plan to sort them. Compared to the relatively mundane activity of the wards, this sort of stuff makes me think I might have made the right choice to forgo a 'life'.
Interesting things I came across worth a mention:
Aerosol Can up a blokes backside. (Lynx deodorant for those interested)
Burns to 80% of a chap after "cooking fish, on the BBQ, with metho"
A waiting room of completely fucking mad patients (as in 10 psych cases) when it was a full moon. (no lie!)
Dislocated shoulders (pop)
Being asked, can you take this patient? they are quite ill and complex, but you're not an idiot so you can manage it (apparently thats a complement???)
Being in ED for 17 hours because 4 doctors (out of 7) Called in sick and almost telling the wrong patient she had a heart attack.
Hearing the medical director of ED (as in, the head doctor) call the administration a "pack of fucking fuckwit cunts who can go fuck themselves with the fucking bullshit they fuck the patient with" in a phone call to administration.
My very own 'house' moment. Lady with vommiting resistant to every medication, no significant medical history but significant use of pot. Other intern couldnt work it out.
I asked 'had they run out of hot water?'
Other intern asked, what relevance had that got?
We went and asked. She had.
Other intern, and patient is wondering how on earth I could have known that.
Its because the patient had "cyclical cannabinoid hyperemesis" which is nausea and vommiting caused by chronic cannabis use, which is strangely relieved by hot showers! Patients present when they run out of hot water.....
BOOYAA!
(course I had seen it the week before and had NFI what it was either first time I saw it! but hey, no-one needs to know that)
Of course I had a few fuckups. No-one died, nothing serious, but not brilliant stuff. First one was not realising the girl in front of me didnt get the bump on the head from falling over while drunk, but rather from her boyfriend abusing her. Second was telling the mother of a 6 month old "we dont need to take blood, you should be out of here in an hour" then having to backtrack...badly.
All in all, It wasnt too bad. Im kinda looking forward to doing it again. Having to work the last 6 motherfuckin weekends though, is fucking fucked.
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It's good to get to the end of a bit of work and feel proud of it, innit?
Hope you're going to have a few more weekends free now!
But seriously, good work