Residency 3.8: ER

I was looking forward to this month as a chance to cram in as much learning as I could, being that I'm interviewing next week for an urgent care job, and this could be my life for the next few years (and even if/when I end up in private practice, there's lots to be gained from good ER training). While the respiratory season is slowing down, it was still a decently busy month, with plenty of opportunities to practice my diagnostic and technical skills.

Two successful lumbar punctures, a deep leg lac requiring a three-layered closure with vertical mattress stitches (something I haven't seen since medical school), nail trephination (cauterizing through the nail to release blood), trauma, shock, new onset seizures, abscess drainage, ingestions, appendicitis, plenty of fractures, asthma, influenza. All the good stuff.

It makes me smile that I think of all that as the good stuff. I've decided I really enjoy the quick pace, the challenge of having a limited amount of time to see a patient and trying not to be lulled into complacency by so many similar complaints, because you never know which vomiter is going to be the pyloric stenosis and not gastroenteritis. And as I've said before, the doctors that work in the ER are some of the most fun people to be around, because they love their jobs and they have to keep things light because otherwise it gets to you.

Things like seeing a little girl in foster care come in with belt marks across her back. Or a teenager who came in after a suicide attempt and you almost pray that he's not resuscitated, because a brain-dead kid with a pulse is harder on everyone than just pronouncing him. Or the boy who was found in a car abandoned after a police chase, with no name and no family. Those days make this job hard. And for me, I think one of the hardest parts is that it doesn't get to me like it used to. But I know that a big part of that is that I've learned to protect myself from it, so that I can still do my job. It's hard to do chest compressions if you're having to think about the outcomes if you succeed in bringing a kid back. Or if you fail.

To end on a lighter note, I finished out the month by swapping arterial sticks with one of the other residents. We need to prove that we can do them in order to graduate, and neither of us have had a chance to do one on a patient, so we offered each other our wrists and stuck each other. Watching the disbelief on the nurses faces while we did it was by far the best part. Well, that, and the fact that now I can graduate.

Pray for my job interviews next week. Hopefully all this experience isn't going to go to waste.