ER is the Worst.

Young women are the worst.
They come into the ER shrieking about their pain being "the worst of my life", they cry when you examine them and they snap at you when you tell them the test results will take an hour to come back. "But we have dinner reservations for seven!"

Middle-aged women are the worst.
They talk down to you for being a young woman, bitch about how their kids are waiting at home for them, then tell you they've had this pain for at least a year and "can you hurry up and fix it so I can go for a smoke?"

Young men are the worst.
They're drunk. They cup your ass when you're stitching up their faces. They throw up when you put freezing into their cuts, and yell at you for hurting them, when they've been in a bar fight that resulted in 7 new ER customers. They hit on you as they leave the ER, despite behaving like jackasses all night.

Old men are the worst.
They tell you they have no pain, that they feel just fine and would like to go home. They don't acknowledge that their chest is filling up with blood and that they're having trouble breathing. They decline pain meds for a chest-tube insertion, then cry silent tears as you jam a finger through their rib-cage.

Old women are the worst.
They pat your hand and call you dear. They say how lovely it is to see a young doctor these days. When you tell them their cancer has metastasized and there is nothing more we can do, they smile and tell you it's ok. They thank you for your help, when you did nothing.

Babies are the best.
They are fat and smiley.

Off to Napanee ER for a month of hard-core community medicine. No CT scanner? No problem!

flow...

As a third year ER resident, you have three objectives:

The first is obvious; you need to increase your medical knowledge to the point where you can manage most crisis situations without having to rely on books/looking things up/phoning a friend.

The second is important as well; you need to learn to interact with multiple health care providers, the general public, hospital staff, police, ambos and miscellaneous drunk people, all while maintaining a professional demeanour.

The third is the hardest; you have to learn "flow". Alas, this is not a yoga term describing the transfer of healing energy. It is getting as many patients through the department as quickly as possible.

A few weeks back, we had a lecture from an ER doc who works in a town between TO and K-town. He told us that new ER grads are "ruining emergency departments" across Ontario. "35 patients per shift" he said. "That should be your target, your minimum."

If you don't see that many, you leave a snarled and tangled mess for the doc coming on after you.

I have kept this in mind over the past weeks. I have increased my multi-tasking.

"Ok, I'll leave the ultrasound machine to warm up in room 5 so I can see if she's having a miscarriage and while that happens I'll give this kid some freezing so I can reset his cast and in the meantime check this guy's ECG to make sure he's not infarcting and order bloodwork from the nurses..."

In theory, it's great.

In practice, sometimes the kid needs you to be calm and reassuring while you jam a needle into his hand, so you have to sit and play and build rapport.

Then, the young woman is indeed halfway through a miscarriage and you have to go in and yank the dead tissue out of her cervix so she doesn't bleed out, and then, by the time you go see the chest pain dude, he's left the department cos he really wanted a smoke and couldn't be bothered waiting for his test results, which are positive. So you chase him around outside trying to convince him he's having a heart attack, all the while keeping an eye out for the drug addict you had escorted from the ER for threatening to kill you and boom! Suddenly your shift is over.

This was last night. I saw 25 patients.

I think I am learning to cover the bases. I may not be a medical expert yet, but my interactions and flow are coming along...Right?