Who has seen ER? I have never watched an episode, but I'm here to tell you that I worked in the ER for a month in January and I'm sure that everything you've seen on TV about the Emergency Room is absolutely true! Ok, that is a lie. So what is it really like working in the ER? It is very different than I anticipated it to be. I expected everyone running around frantically with total chaos trying to save as many lives as possible that were on the brink of death. What is the reality? There is a very methodical and structured atmosphere in the ER. I learned a great deal about what those physicians face on a daily basis and also how the entrance point to health care for many is structured.
Let me begin by painting the picture of the particular Emergency Department(ED) I worked at. Grant Medical Center is located in the heart of downtown Columbus. I described it in my earlier post about my OB/GYN rotation because I did these two rotations at the same hospital. It is very inner city, and not the safest area of Columbus. It was a common thing for thugs to drive their car to up to the door of the ED, push a gun shot wounded buddy out of the car, leave him on the curb and drive off to avoid questioning from the police. The ED is a Level 1 Trauma center, meaning it has the resources and specialists to handle the worst of the worst trauma cases in the state. Another interesting fact about the Grant ED is because of its location, the patient population comes from a very poor socioeconomic class. So hopefully you get the idea of the conditions. What was my role as a medical student in the ED? It was much more independent than any of my previous rotations had been. I was used to working closely with one physician and followed very closely what they did, breathing when they told me to breath, doing only what they wanted done, you get the idea. In the ED, I worked with a different doc every day, with the first doc I worked with telling me he didn't need a shadow and to only contact him on the radio after I saw a patient. I was to watch the computer, pick a patient to see, do what I thought was necessary, and report to him. Hello. Wake up call. I'm pretty sure he thought I was a 4th year who knew what he was doing rather than a 3rd year with no ED experience and only 5 months of rotation experience to date. It took some getting used to, but by the end of the rotation, I really enjoyed the independence and trust given to me. Before you get too concerned about a med student seeing people in the ER alone, I would always look at the vitals before seeing a patient to make sure it wasn't a true emergency, and then I would see them. I gained valuable experience interviewing patients and doing physical exams. I was forced to think through situations and got to help decide what the best course of action was for my patients. I got a lot of practice putting in IV's, Foley catheters, and doing other procedures. And when the big trauma's came either by life flight or ambulance, I got to witness first hand the valiant people who worked so hard EVERY time to save lives. Here are a few of my observations(for some it may dishearten you and for others it may shed some light on why healthcare costs are out of control in this country) :
1. My favorite experience of something I did myself: It's a tie between using a pair of pliers to yank out an industrial staple from the finger of a 62 year old man(that I numbed up with lidocaine of course) and stitching up a 3 inch wide by 2 inch deep cut on a 25 year old man who punched a window on new years eve because he was drunk and angry.
2. The craziest story about a patient: There were a lot of crazy stories, some being factual and some contrived on the part of the patient so they could get their pain meds, but here is the best factual one. On new years day, a gentlemen who we will call george, reported to the triage nurse of face pain around 4 am. He said he was hit in the face by someone or something but wasn't sure what and that he was "minding his own business" when it happened. So the nurse put him in a room to wait for the doctor to see him, figuring it was not serious and did not need urgent care. Well, I show up to see him 3-4 hours later (it is really busy on new years day in the ED) and he has a blood stained nose that is very swollen. He tells me a similar story to what he told the nurse, and so the attending doc decides to get a CT scan of his face to rule out anything major. Well, a few hours later, the CT scan shows shrapnel from a bullet that is throughout his sinuses and underneath his skin! This man had been shot in the face! He should've been a trauma patient and seen immediately but instead waited 6 hours before he got attention! I don't know if this guy was trying to hide something or really had no idea he'd been shot in the face, but we were all grateful no important structures were damaged. Crazy, eh!
3. 90% of patients in the emergency department do not need to be in the ED. Period. Sadly, most of the patients in this ED either presented with strep throat, colds, headaches...things that they should've seen a family doctor for, or came in with stories of pain in order to get the narcotic pain meds that they were either addicted to or are going to sell on the street. The reality is there is a small part of our society that uses up a considerable amount of resources. They treat the ambulance as the big red taxi to the hospital to get their pills. They know they won't be turned away if they can't pay, so they come for anything and everything. They say the right buzz words and the ER doc is forced to order CT scans, lab tests etc that cost thousands of dollars in order to protect himself from the people who are trying to play the lottery and find a doc who "messes up" so they can sue for millions of dollars. It's a very sad and disheartening reality. I believe this is a big reason why medical costs have skyrocketed. That is all I want to say about politics.
4. Emergency Physicians surprisingly have very good lifestyles. Most work 18-10 hour shifts a month and get the rest of the month off. The average pay is 300k. They are contractors for the hospital and don't have to worry about starting an office and absorbing those associated costs. I loved working in the ED for the first 3 weeks of the rotation while working days, but absolutely hated it when I worked the overnight shift several times during my last week. That is one of the downsides with emergency medicine. Also, you will likely work a lot of nights, weekends and holidays. They have one of the highest burnout rates of any physician. It is a very high stress environment, especially at night.
5. The most exciting trauma: Seeing the skin and some facial muscles dangling from a man's face after he hit a tree driving a car under the influence of alcohol. He survived without any brain damage...it was pretty crazy. It was cool to see that no matter what the person did to get to the trauma room, they received the same great care.
I really enjoyed the rotation and strongly considered going into EM for a while, but for some of the reasons stated above have decided against it.
