Reflections on Dawn of Last ER Shift

Tonight will be my last ER shift until January. It has been a really good month in many ways with fire-hose style learning and many exciting procedures. This month has certainly held the highest and lowest points of residency thus far (which does not say a lot given that this is only the completion of the second month). I enjoyed the atmosphere of the busy emergency room and appreciated working on critical thinking and clinical decision making, improving efficiency, and sharpening communication skills. The ER is a great place to learn but a good place to leave as well in order to avoid burnout. Certainly this place takes its toll on everyone. I respect those steady souls that thrive in and enhance the atmosphere of the emergency room by their confidence, efficiency, and peaceful demeanor.

On the eve (or dawn) of my last ER shift, I wanted to share some highlights from the month:

- Taming the Unit Secretary: As unit secretary and battle-scarred veteran of the ED, "Polly" is arguably one of the most powerful people in the emergency room. Polly is to the intern what Goliath is to David, what the jungle cat is to its prey. She basically eats us for lunch. At the beginning of the month, P told me that she was "going to beat me" when I made an incorrect move; she nearly threw an elbow when I attempted to take a chart from her desk to add a patient order. As a people pleaser and affection-seeker, I set out to "tame" Ms. Polly by the end of the month. I put in "pages" to physicians independently (instead of making her do it), I gave her a heads-up when I was anticipating a call, I complimented her and joked with her. Now she smiles at me and kids with me freely. At times, I think she may still be laughing at me internally but from all outward signs, our relationship is peaceful now.

- Disimpacting the Diarrheal Patient: Whenever a patient or his/her family complains of blood in his/her stool, we have to do a rectal to test the stool for blood. One night I made the intern error of trying to do a rectal on a patient with bloody explosive diarrhea. Instead of waiting for a dirty diaper, I attempted a rectal and got a lot more than I bargained for - all over my face, scrubs, and the little girl's dad. "New scrubs to the ER...STAT!"

- The Beauty of versed - One particularly anxious four year-old girl had an abscess that needed to be drained. Based on her violent display of apprehension at my looking in her ears or mouth, we knew that we would have to sedate her for the incision and drainage of her wound. I cracked up with her mom when after the anti-anxiety/sedating properties of versed changed this little girl from crying when I entered to the room to drunkly slurring, "You and me's friends...will you come over to my house and play?" as I drained and cleaned her wound. Thank goodness for good medicine.

- Practice makes better I hope - One of my most difficult patients this month was actually not that sick. She was a young asthmatic that needed to be observed overnight in the hospital. In the busyness of the night and insufficient updating, the mother balked when we told her that her daughter needed to be admitted. The nurses were unable to convince her that an admission was necessary, so I went to diffuse the situation. After 15 minutes of explaining the situation and reasons why her daughter needed to be admitted, this formerly reasonable mother, tired and frustrated, refused admission. Tail between my legs, I had to tell my attending that I could not convince her to stay; speaking to her for another 15-20, my staff was able to talk her down and get her to stay with her daughter. I hope to gain the communication skills necessary to set expectations with families, explain difficult scenarios with challenging parents, and diffuse intense, stressful situations.

- Setting high that bar - One of my favorite staff from the month shared at one point that he calls all of the patients that he sees in the ER on the following day to see how they are doing, as well as checks on the patients that have admitted to the hospital. He spent a couple weeks out of this month in China working with Operation Smile to serve the medical needs of children that have limited access to healthcare. I was inspired by his commitment and compassion toward children in Louisville and across the globe.

- Gaining trust - It has been exciting to begin to gain trust with staff and patients alike. There is nothing more encouraging that having a staff leave the room during a procedure because they trust you or complimenting you on your technique/management skills. Perhaps even more encouraging have been the patients that have been relieved when they found out that I would be the one sewing their wound or doing their child's spinal tap. These are the moments that make stressful days and long hours worthwhile.

Many more adventures ahead...thanks for sharing them with me.