The ER: not like TV

Ok, the ER is NOTHING like the TV show makes it out to be! Well, I shouldn’t say nothing, but it’s really much more mundane than the show lets on. There are crazy people for sure; there aren’t enough psych beds for all the people who need them, so often they sit in the ER for days until a psych bed open. Last night, a man was banging on the locked door of his room, screaming for hours, while the guards sat outside his door and we tried our best to ignore it. There’s also the demented old ladies, who start making Xena war cries when you try to listen to their hearts and wander out naked if you’re not watching. There’s also the spectacular cases, the young healthy person who spontaneously gets a head bleed, is rushed in and has to be intubated emergently and a hole drilled into her head ASAP; or the guy who comes in actively seizing and you need three burly guys to hold him down while you try to inject medicines in him ASAP. But for the most part, most people you see are a lot less exciting. Lots of shortness of breath, chest pain, back pain, broken bones, fevers, stomach pains, etc. And to set the record straight, as far as I can tell, there’s NO doctors having sex in the laundry room!!

I’m not fond of ER work, as I am a slow, methodical person, and I don’t like thinking fast, but it’s been good for me. Though I understand the need for electronic records and Frank is an electronic medical records guru, it’s AMAZING how much faster I am when I don’t have to type my notes as I go along, I don’t have enter in computer orders, and I can just dictate away. I’ve seen some children and pregnant women, which I REALLY didn’t want to do, but actually, being in Nigeria helped me as I did see lots of kids then. As I’m wont to, I’ll tell you a story which I think represents my ER experience so far, meaning, horrible, great, and humorous, all at once!

So two days ago, at 7 AM, I picked up the first chart, which was a pregnant lady coming in for vaginal bleeding. Great, I thought. Not only do I HATE doing pelvic exams, she’s pregnant! I was terrified I would do something stupid and miss something very big, like a miscarriage or something. So I tell the ER attending physician that I’m not very comfortable with Ob-Gyn. He says, “great! This’ll be a good chance to learn. Go in there and see her.” Ok, then. So I go in there. It turns out that she’s not only a few months pregnant with a few days of bleeding, she doesn’t speak English, this is her 12th pregnancy, and she’s only seen a doctor once before this. I do the vaginal exam; it takes me forever to find the cervix; I think I found it, but I was terrified I had missed something---had I missed it somehow, and didn’t see she was bleeding like mad, or that there was tissue hanging out, or something obviously very bad? It’s hard for me not to have noticed something like that, but I just didn’t want to mess around with someone’s baby! Calm down, I tell myself. She’s probably just bleeding, and the baby’s fine, you’re overreacting. So we send her to Ultrasound. Her labwork comes back and everything seems fine. The Ultrasound report comes back; there is NO baby in the uterus. Uh oh! So I call the Ob-gyn doc, who comes to see her, and reassures me the patient probably miscarried by then and there was nothing to see, and the patient is fine, she should just come to be re-examined in Ob clinic tomorrow, but I’m feeling wretched. The first patient of the day, I’m already terrified, and I have to tell her she miscarried. I’m a wimp; the ER attending sees her before I do and breaks the news himself. He can probably tell I’m scared and doesn’t trust me to do a good job of breaking it to them, which is probably true! It's better for them that someone more experienced than me is talking to them about it than I. I guess I should’ve been braver and gone back in there. But this is one of the exact reasons I didn’t go into family practice; let someone else deliver babies and break this kind of news, not me! (do stories like this inspire confidence in you as to what kind of doctor I am???? I realize I shouldn't be telling people how terrified I am---but really, underneath it all, no matter how terrified I am, I do what I have to, and that's all there is to it. I'm still learning. But terrified or not, I don't think I've made any big mistakes yet---pray really hard this remains true!!!)