Those stupid ER Docs

I am in my second year of Emergency Medicine Residency. It is an interesting specialty because we tend to be universally hated by every other specialty because they view us an "unintelligent" since we are not as skilled at their specialty as they are. Hence the following statement, albeit in jest, by my ICU attending,

Attending: This lady suffered an anoxic brain injury and will probably end up in a vegetative state, she must be applying for ER residency.

Of course, I reply with a hearty laugh and let it roll off my shoulders. The truth is I wanted to say, "do you even know what we deal with in a day?" "Do you really, truly think we call you for every old guy with a cough?" "Do you realize that yours is probably the only specialty that you are more versed in than a fully, residency trained ER doc?"

Now, I would never say these things because they are not helpful. We, as ER physicians are put in a place where we are viewed as stupid because any time we call another specialist, we are asking for help. Yes, maybe this is the third abdominal pain I am calling the surgeon about in a single night. But I am not a surgeon and I need help with this particular case. The surgeon is not aware of the 10 other abdominal pains I already sent home that night.

So from an ER doc in training, I apologize that I am not as good at all other specialties as my own, and I am sorry that whenever I call I am giving you work to do. But I have to say that I do not view an ophthalmologist as stupid because he probably couldn't diagnose brugada syndrome on an EKG, I don't view an orthopedic surgeon as stupid because she would have a hard time performing RSI. I don't think the hospitalist is unintelligent for not being able to emergently perform a lateral canthotomy. We, as emergency docs, have to be able to do all these things and sometimes, we have to ask for help. So, can't we all just get along? (Insert "Why can't we be friends?" here).

So I'm a Resident Now

I have just completed one month of residency and this is the main thing so far that I have found that is different from being a medical student...

As a medical student I usually felt somewhat justified when I didn't know something. I mean, after all, I'm only a student! I'm still learning! Now, I just feel like an idiot almost 24 hours per day. I mean, I second guess almost every little thing I do. I'm not even comfortable giving someone tylenol. I nearly poop myself any time a nurse wants me to make a decision about a patient. But that's okay. All part of growing up. Besides, at least the hospital has to do my scrub laundry.

Now, completely off topic is my patient-resident conversation of the day, or I guess of the year judging by how well I have been keeping up...

Patient high on Benzos while I'm irrigating a giant laceration on her arm: (jumping off the table)What the @$#%!
Me: Oh, sorry, did that hurt?
Patient: No! Don't you realize that my dress isn't squirt proof?!?
Me: Uh, what?
Patient: Shut up! I'm trying to sleep!
Me: Yes mam.

That's right people. Another life saved.

Matched!

That's all I have to say! Goodbye Medical School!

What is pimping again?

Well, it has been about 3 months now since any attending has asked me a serious question about medicine. Does that mean I have forgotten everything? Yeah. Mostly it does. My thoughts as of late mostly center around when my next meal is and what I have to do in order to escape medical school.

Today:

Attending: Okay you two. Name the most common areas for an aneurysm in the brain?
Me: (looking at ceiling, thinking about lunch)
Other student: blah blah blah (gets it right)
Attending: Good! Now what are the most common brain tumors in adults?
Me: (still thinking about lunch, also wondering why he has never tried nacho cheese in a burrito. I know! Sounds awesome right???)
Other student: blah blah blah (gets it right again)
Attending: Great! (looks at me) She is so much better than you.

Shortly after this my phone was confiscated by this attending because I was checking my email.  I has gots to get out! Luckily this eval wont be on the MSPE...

Also, Nacho Cheese, as it turns out, is not that good on a burrito.

Okay fine, I will update you all

Here we go.

What to say about 4th year?

Magical? Yes.

Enchanting? Yes.

Expensive? Holy freaking crap yes.

I must say that I had no idea that I could spend the massive amounts of money that I have been spending on interviewing this year. Looking at my credit card statement is much like looking at Mt. Everest and contemplating a climb. Both give you this sense of utter hopelessness. Ah well. That's what loans are for right? After all, we all know this is fake money.

Interesting interview dialogue of the month:

Medical Student: Hello Dr. Attending, it is a pleasure to be interviewing at your institution
Interviewer (in slow, dramatic voice): Why. The. F*CK. would you want to come to this place?
Medical Student: I, uh, thought that, uh...
Interviewer: Ah that's okay. Did I mention that my greatest hobby is carving meat?

I have a good feeling about this place.

Is it okay if I rant?

Last week I was assigned to follow a Physician Assistant for a day since the MD was out of the office. I have nothing against PAs. But this one was really starting to rub me the wrong way (figuratively speaking). 

PA: Medical Student, go assess these patients.

Medical Student: Okay.

Medical Student: Patient number one has a cough that comes in paroxysms with post-tussive emesis. He has had the cough for 6 weeks. I think we should cover for pertussis.

PA: Um, no. It's just viral.

Medical Student: (what the @#%$@!!)

Medical Student: Patient number two is a well child check. Everything was fine but there is a 2/6 systolic murmur at the apex. I think it should probably be checked out.

PA: (listens at the 2nd and 4th ICS) Nope. No murmur.

Patient's Mom: I think he's right, we have been told he has a murmur and that he should have a "heart ultrasound."

PA: (listens at the apex) I found a murmur here.

Medical Student: (glares at back of PAs head)

Medical Student: Patient number three has perfect circular patch of hair loss with a boggy mass on his scalp. It's classic for a fungal infection. I think we should treat him with an oral anti-fungal.

PA: Nope. This is a lipoma or maybe a sebaceous cyst.

Medical Student: I really don't think...

PA: We need to cut it out.

Medical Student: Should we try an anti-fungal first?

PA: Nope. We need to cut it out. (makes an incision on patient's head) Weird, there is nothing in here. Oh well, stitch this up.

What a day.

How the Dementia Patient Out-smarted Me

Every once in a while you have to let go of your pride and admit that someone has gotten the better of you. Whether it be sports, politics or even the world of medicine, the time is sure to come. It just sucks when the person who gets the better of you has dementia. 

One of my patients in clinic today appeared rather confused so I decided to perform a mental status exam on her...

Medical Student: Okay, can you spell world backwards?

Patient: No.

Medical Student: You don't want to try?

Patient: Why would I do that?

Medical Student: Okay. um, I'd like you to take this pen and draw a picture of a clock face showing ten past eleven.

Patient: Fine. (starts drawing) There. (shows me picture of a circle with 11:10 written inside of it)

Medical Student: What's that?

Patient: It's a digital clock. 

Medical Student: You win. I don't care if you think the president is Woodrow Wilson.