Life in the ER

Shadowing a doctor is one way for medical students to get a taste of what practicing medicine is really like.  The Wightman-Berris academy at the University of Toronto has a faculty mentoring program whereby students are matched to a doctor in a discipline of their choice.  I chose emergency medicine because I thought it would be interesting.  There’s a lot of variety in what patients present with, and you never know what the next person will have.

What follows is a FICTIONAL account of what an evening shadowing an Emerg Doc might be like.  No real patient information is used.

I arrived at 9 PM.  I met my faculty mentor, who seemed to be in the process of doing 10 things at once.  A CD containing CT scans of patient had gone missing.  A neurosurgeon had been called in for a consult, but couldn’t do anything without the images on the disc.  Tempers were short.  The ER seemed to be in complete chaos.  The waiting room was full.  Every examining room was taken.  The emerg doctor was saying “Move the bar fight from the ENT room to ONE, put Chicken Bone in the ENT room, and put Cat Bite in FOUR.”

A white haired old lady was lying on a bed in the hallway next to the nurse’s station.  Every once in awhile she would suddenly start screaming “THE PAIN, THE PAIN, THE PAIN!” in an eastern European accent and then stop just as quickly.  No one paid her any attention.  I went over an asked her what was wrong.  She lifted up her gown and showed me a nasty scar running along the outside of her thigh.  It was red and swollen, and her skin was flaking off around the wound, and I smelled a foul odor.  Apparently she had broken her hip in a fall and had required surgery. 

I asked her a couple of questions about her fall and she told me her life story.  Her family had fled from Hungary and gone to Brazil at the end of WWII because of communism.  She had been living in Canada for 30 years.  Her son was “no good”.  He had taken her home and everything she had, according to her, and put her in a nursing home.  I listened for about half an hour (my mentor was still too busy for me) until the transfer team came to take her back to the nursing home.  By the end I realized that she was racist.  At one point she said that “Canada used to be a nice place 30 years ago before all the coloured people came.”  I felt a little less sorry for her, and then felt a bit ashamed.  Did it matter if she was a racist?  She was still a patient who needed help.

Soon I was following my mentor from patient to patient as he tried to keep up with the constant influx.  Most people had been waiting between 4 and 6 hours, which was apparently not that bad.  It could get much worse.

There was a schizophrenic with diabetes.  He thought the doctors were trying to poison him.  He had back pain and wanted an X-ray.  It was a tough situation because he refused to get blood work yet it was likely poor control of his blood sugar that was causing his physical symptoms.  In the end, the doctor managed to convince him to voluntarily be admitted to the psychiatric ward for the night.

Next was a girl who had landed on both knees while playing basketball.  An X-ray revealed no fracture, and she was sent home with orders to ice it and rest.  Another man had lacerations on his face from a bar fight, and needed sutures. 

Later, we examined a woman had been bitten by her friend’s cat on her hand, and now, only a few hours later, the bite was red and swollen (obviously a Pasteurella multocida infection).  She was given an X-ray to make sure there were no tooth fragments in her hand as well as antibiotics and a tetanus shot.  Her hand and forearm were put in a sling and she was sent home with instructions to come back in two days.

There was another 85 year old woman spoke no English.  Luckily a nurse was found who could speak Portuguese.  It turns out the woman thought she had a fish bone lodged in her throat.  She was also suffering from dementia.

A second old woman who didn’t speak English would repeatedly pull the IV out of her arm, getting blood all over her sheets.  She would shriek hysterically.  How do you deal with that situation?  Luckily there was one young nurse who would patiently put pressure on the old woman’s wound and then redo the IV.  She said that most nurses would have restrained this particular patient by now, but she felt that she could calm the patient down with soothing words (even if the patient could neither understand nor appreciate what the nurse was doing).  The nurse said she didn’t mind having to come back to redo the IV.  I was impressed by her compassion.  

Her shift was supposed to be over at 11:30 PM, but she was still there at midnight because it was so busy.  The doctor didn’t even notice.  But I did, and I’m glad she was working that night because I saw that despite the never ending torrent of patients washing through the ER, it was still possible to care.

8 thoughts on “Life in the ER

  1. There are still health care workers out there who care? I don’t believe it! Or is that the “fictional” part of the story? lol.

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