Emergency Medicine

I spent the month of May in the lovely town of Scottsbluff, Nebraska doing my emergency medicine rotation. It was a lot of fun to be able to see a variety of conditions. I was hoping to see more trauma (I really like the blood and guts), but I guess a small town in western Nebraska doesn’t have too many gunshot wounds or stabbings.




I was able to stay with my brother and sister-in-law and their six children. It was a little crazy (and I was happy to return to my regulated little apartment), but I loved being able to have time to spend with them. I got to go to a nephew’s graduation, be there for a niece’s birthday, and spend almost every evening reading bedtime stories and brushing our teeth together. [Would I live there? Definitely yes: I loved have something scenic to look at while running, the wide open spaces, and Johnny and Jessica live there. The city is big enough to have two LDS wards and even a Target! If we could get a deal with Jeff getting his loans paid off, we would do it (I think we would go anywhere, since we are in loads of debt and will likely triple our current debt by the time all is said and done)]

What I loved about ER:
-Variety
-Stitching, stitching, stitching (I think I’m a pro at suturing)
-Trauma (the blood and guts stuff: elderly falling with no visible cuts is far less exciting)
-Quick Pace
-Hours (It is shift work, meaning you work 12 hours shifts and don’t have to stay after unless you have paper work to finish. Unlike clinic, where you’re essentially putting in 10-11 hour days because you have to dictate (document) in patient charts, you chart during your shift so you can normally leave. This is pretty ideal for someone like me who’d like to have time at home with the kids but will have to work full time.)
-No Follow-up (meaning once they leave the ER, they aren’t your patient anymore. This is nice because you get some very needy patients and the unlucky family practice physician has to deal with them all of the time)
-The Funny Stories. Sometimes the reasons people come into the ER are pretty ridiculous but what is even more funny is the story they give you about what happened. Wait, how did you get a cucumber stuck up your butt? :)

What I didn’t love about the ER:
-Drug Seekers (you know, the people who come in with “pain” who really just want narcotics)
-Overnight Shifts [the worst was getting pimped (asked questions) by the physician at 3 o’clock in the morning. Seriously? If you wanted a decent answer, you should have asked when the shift started]
-No Follow-Up (meaning you never know what happens to the patient once they leave the ED or get admitted to the hospital. To look it up would be a violation of HIPPA or patient privacy)
-Definitive Diagnosis: essentially in the ER you always get an x-ray or CT scan (both to cover your butt and to determine the diagnosis). This is nice because you almost always know what it is (or isn’t), but sometimes when discussing what I thought it was based on the clinical presentation, I would get the “well let’s just see what the scan shows.” Don’t get me wrong: you still have to use your knowledge base to rule out different medical conditions, but sometimes it’s a bummer to “wait for the radiology results”.
-Malpractice: this is a problem in every field, but especially in the ER because you don’t want to miss anything. If a lady comes in regularly for migraines but you miss the one time she comes in for a stroke, that’s a lawsuit. So you always have to step lightly.

A few notes:
-In the medical field, we actually call the ER the ‘E-D’, which stands for the Emergency Department. This was changed because it would sometimes get confused with the OR (operating room)
-If you are going to go to the Emergency Room, it is very expensive (you have at least a $75 co-pay at the door, the hospital facilities fee (~$200+), the physician fee (~$200+), a scan [X-ray or CT scan] cost (up to thousands of dollars), and radiologist fee (the physician that reads your scan in much better detail), so that comes to about a $500 minimum. So I would recommend you try to get into your primary care physician/pediatrician first or urgent care as a second if you want to save money.
-When not to go to an urgent care: a lot of bleeding (a very deep cut that may have gotten your blood supply), a possible broken nose (you have to get a CT scan), an eye injury (a bleeding, possibly broken bones eye: getting something stuck in your eye or scratching your eye while taking out your contact can be handled by your primary care), most car accidents, broken bones (they will not typically set or cast them)
-When not to go to the ER: if you have a chronic problem, then it is not considered an emergency and so you’re paying a lot of money to get nothing done. For example, a lot of people would come in with chronic knee pain and we really didn’t do anything because what they need is an MRI, but since it’s not an emergency, we can’t order/schedule it.
-If you are to dismember yourself (may none of us have to experience this), you should always bring the other half to see if we can salvage it.
-Getting stabbed is a terrible result of road rage. Don’t tail someone who cut you off—it never ends well!

Everyone I talk to always asks me what my favorite rotation has been and what I want to pursue when I graduate (which is coming up in December!). It is hard because every specialty has its pros and cons and I’m also trying to take into account the flexibility and the potential of me working part-time in that field (when one day we can afford for me to be a halfway stay-at-home mom). So here’s my short list thus far:

-Emergency Medicine
-Dermatology
-Inpatient Medicine (hospitalist)
-Surgery
-Pediatrics

And as it is my week of summer break, I hope to be posting more about rotations and just life in general soon!