The n00b Files - Weeks 1 and 2 of Emergency Medicine

Working in the EC of my school's county hospital was a welcome break, to a medicine-minded (as opposed to surgery-minded) girl like me, from being in the OR a lot. It was also an opportunity to learn yet more things, some of which I shall record here:

Lesson 1:

Sometimes patients flirt with you. This can lead to very conflicting emotions. On the one hand, these patients are often people with debilitating, chronic illnesses, and you can see that this is an exciting interaction for them--and they don't get very many of those. On the other hand, you kind of want to clock them super hard for hitting on you in your workplace.

Lesson 2:

Apparently, as women progress into the later stages of pregnancy, their bellies get so heavy that if they sleep on their right side, their inferior vena cava (IVC) is compressed by the uterus, and they can't breathe well at night as a result. So a lot of women who are pregnant end up preferring to sleep on their left sides or backs instead. I found this news a little upsetting, since I LOVE to sleep on my right side. Does this mean that if/when I am pregnant I'll have to switch sleeping sides? And if I do switch sleeping sides, will I find myself continuing to sleep on my left side after delivering, or will I switch back to my old habit? There's so much uncertainty in my future!!

Lesson 3:

It's amazing how quickly two days off from work can make a person feel lazy to the bone and utterly useless. It's also amazing how one 12-hour shift in a county hospital's ER can make a person feel like they've worked for days on end, even when they've just come off of 3 days of vacation.

Lesson 4:

Turns out I'm pretty interested in women's health issues. I saw a lot of interesting OB/gyn cases while working in the ER, and I found myself really wanting to follow up with those patients and find out what happened to them. Kinda cool.

Lesson 5:

Altered mental status sure can sneak up on you. I had a patient who just seemed to be in a lot of pain and probably had strep throat with complications. A couple hours later this patient started acting strange and forgetting simple things. BAM, the patient is transferred to an isolation room and I'm sitting around worrying that I have meningitis droplets all over myself and my white coat. Thankfully, the patient probably didn't have bacterial meningitis. Something weird was definitely going on though, and I totally didn't realize it at first.

Lesson 6:

A lot of people show up in ERs for completely non-emergent reasons. Some people just call ambulances when they feel lonely or are suffering from slightly-more-than-normal pain from their arthritis. While it can sometimes be gratifying to help these patients by giving them some human interaction (which I'm pretty sure is all they're really looking for), it can also be frustrating to see them taking up beds in the ER when patients with actual medically urgent ailments are still in the waiting room.

Lesson 7:

I put in an IV while I was in the ER! I know this isn't a lesson, but I was kind of proud of the accomplishment, so I decided to count it as one. Here's the lesson: with a good teacher (a really nice nurse showed me how), even a daunting task can be accomplished successfully. Of course, it didn't hurt that my patient had really nice veins, too.

Lesson 8:

If a patient complains of generalized throat pain that gets much worse when you push posteriorly on their hyoid bone, they might have epiglottitis, which is a pretty scary thing to have, indeed. Most young people can't get it, since it's caused by a bacterium that people have been immunized against for decades now, but patients 50+ are still at risk.

Lesson 9:

Learning the dosage of narcotic pain medications is worth one's while. I'm sure most people have it completely memorized by the time they finish med school, or at least intern year, but here it is:

for morphine, give 0.1 mg/kg

1 of Dilaudid is worth 8 of morphine

for Fentanyl, give 1 microgram/kg.

Keep in mind that Fentanyl is really short-acting, despite being very strong.

These lessons may have been a little boring...

The n00b Files - Week 1 of Transplant Surgery

More things I've learned, some more pleasant than others:

Lesson 1:

One of the best things about being a surgeon is that you get to make people listen to your favorite music when you operate, if you're so inclined.

Lesson 2:

One of the worst things about being on your surgery rotation is that you have to listen to your attendings' favorite music while they operate, if they're so inclined. Sometimes you like their music, and you jam out to Chumbawumba and Third Eye Blind and Hootie and the Blowfish behind your mask. Other times it's lots of Nickelback and Lifehouse and really bad Top 40 and you feel like your ears are bleeding.

On a related note, it's funny when middle-aged white surgeons have club music on their playlists.

Lesson 3:

LUNGS ARE HUGE. I'm talking, each lung is like twice the size of my face. On the real. They're all puffy and somehow remind me of two large-ish Teddy bears. I saw live lungs for the first time last night. Crazy thing.

Lesson 4:

Organ transplantation, when successful, is a wonderful thing, giving recipients a new lease on life. What one often doesn't think about is organ donation, which almost always happens when a patient dies. I came face to face with that part of the equation last night during an organ harvest. It was surprisingly disconcerting to see the patient wheeled into the OR, and then to see the patient's vital organs being removed and the patient's life blood being flushed out. All a part of the circle of life, to be sure, and organ donation is a way to make a senseless death worth something more to others. But all these things being true, it's still a difficult thing to stomach, at least at first.

Lesson 5:

I apparently have a tendency to experience dysphagia (ie, difficulty swallowing) and subsequent throwing-up on mornings after I've had very little sleep the previous night. I've had two such nights in my 5 weeks of the surgery rotation so far, and I've thrown up on both of the following mornings. This has happened to me in the past before, too. This can't be good, as I'm sure residency will put me in this very situation many, many times. Must learn to pace oneself in the morning instead of trying to nom after a long night.

Lesson 6:

If you don't watch sports, it might be smart to start doing so in order to interact with a large number of patients during semi-awkward situations. One of my teammates last month could always talk to patients about sports while changing their bandages in order to distract them from the pain. I usually stood mute, especially when the patient was a man and I was pretty sure we had nothing in common. The talking-about-sports route was much better.

Lesson 7:

When asking questions to attendings, be careful not to ask too many questions that reveal your lack of knowledge. Otherwise you might find yourself being told to research your own question and report back to the attending the next morning. Which is what happened to me today when I asked one too many questions about the steps of a kidney transplant. Drat!

Lesson 8:

Sometimes people are just kind of crabby and prone to snapping at you. That's pretty crummy.

Lesson 9:

You know how on Grey's Anatomy, whenever they're doing a transplant they anxiously wait for the organ to "pink up" while thoughtful music wells up in the background? Yeah, that happens in real life, too. I got a bit of a kick out of that.

Lesson 10:

You'd be amazed how quickly a pink bowel turns white when it's not getting blood flow anymore. Conversely, if you look away for a second after a kidney transplant has been attached to the recipient's blood supply, you'll miss the magic moment when it goes from being white to being a rich purplish-pink. Blood flow is cool.