ER is over

Today was the last day of my ER rotation. That’s 5 of the 13 rotations for this year done. Yeah!! The ER was nice – I worked 21 eight hour shifts and had 7 days off. The shifts ranged from 7am-3pm, 9am-5pm, 2pm-10pm, 5pm-1am, and 11pm-7am. I saw quite an array of people with lots of differing personalities and problems, ranging from no reason for being in the ER to every reason for being there and very sick. Here are examples of some of the more interesting things I saw:

An older man who had a tumor growing on his head for a year before seeing a doctor finally because it was giving him headaches and leaking lots of junk on his shirts. It was about 5 inches wide and 1-2 inches deep and was eating into his bone. We took a biopsy and he ended up having a really bad squamous cell skin cancer. He will need a lot of work with plastic surgery to try and fix it.

A teenage girl who came in 1 week after being diagnosed with strep throat with no other medical problems. She was put on an antibiotic and had a rash appear on her stomach and the front of her legs, and we thought it was just a reaction to the antibiotic. We got some basic labs that came back showing signs of cancer. Further testing showed she had a new leukemia (blood cancer).

A lady had back surgery about 10 days before and had gone to a rehab center. She was not having very many bowel movements and started having a lot of pain and bloating in her abdomen. She ended up having a hole in her large intestine from all the pressure that had built up and was quite sick from it. The CT scan of her belly showed lots of air in her abdomen (a really bad sign) and she was rushed to the OR, where a large part of her bowel was taken out and she was in the ICU on a ventilator for almost a week afterwards recovering.

A man who was wheeled in by EMS with really bad chest pain. We were sitting in the other room and heard, “I need a doctor and nurse in the room now!!” so I rushed in after the attending doctor to watch. The patient had stopped breathing and had an abnormal heart rhythm. The doc ran in and gave a large thump with his fist to the man’s chest while the machine was getting ready to shock him. I think he ended up being shocked 3-4 times before he came around and said “Ouch!” with the last one. He was rushed up to cardiology to get a rapid procedure to look at the blood vessels to his heart, and they found a giant clot blocking the main vessel in his heart. He is so lucky because if he had been at home when he lost consciousness, he wouldn’t have had the machine there to shock him, and so he probably would be dead.

A lady who got something in her eye from raking leaves. We placed a fluorescent dye on her eye and then used a machine called a slit lamp to look at her cornea to see if there were any abrasions (cuts), which would fluoresce a light green color, and I got to see it.

I got to suture (sew) up a few people’s lacerations – one on an eyebrow and one on a head – all by myself, which was so much fun.

I would go see the patient, then talk with the doctor over me, and we would talk about the possible things going on and decide what labs or other tests to order. It was a nice month because the ER is run by the attending doctors, and we are there more to learn than to run it. So we could go a little slower and take time to learn about our patients. I also enjoyed the people I worked with.

There were some frustrating things that would keep me from choosing ER as a career: 1) I saw firsthand the problems that our current healthcare system has with respect to the ER – so many people who use it as their primary care office because they don’t have insurance so they don’t go to a regular doctor, which drives the premiums and taxes up for everyone else; 2) I got annoyed by people who use the ER like McDonalds: they think they can come in, pick and choose (sometimes demand) what tests they want ordered or what pain medicines they want, and then get mad when things are not done as fast as they like because they need to be somewhere else; 3) I don’t like the lack of continuity of care while working in the ER – you see patients, figure out what is going on with them, and then send them out, and it is hard to know what happens to them. I guess if anything this year continues to make me more and more excited for the upcoming training when I will get to learn dermatology, which I am liking more and more the more I see of it.

In other news, Kolby has now done 2 weeks of piano and loves it. He can already play a song that is recognizable (“Merrily we roll along”). The boys had doctor’s appointments this week for well-child checks and they all seem to be doing well. We went on Thursday to JC Penney to get a family picture that we will send out for Christmas. The lady who did our session was the same one who had taken the pictures of the boys in their Halloween costumes a few weeks ago, which turned out so cute, and she was so good again this time – we want her to do it for us every time we go. I can’t wait to get the pictures back – they turned out so nice. Thursday night was Daddy-Eli night and we went to see Wall-E together. Eli was so excited to get a little bag of popcorn and watch the movie on the big screen. We took the van in for a $20 oil change on Friday that ended up costing about $400 – the area where you put the key in locked up and so we had to have a locksmith go to the car place and replace that; the battery was dying and needed to be replaced; and we got the oil change. At lease that van works so well for us most of the time. Yesterday Kolby had a practice for his primary program that he participated in at church today. We had dinner tonight at the Eccles, a family in our ward. The kids had so much fun playing together and we had fun just talking. It has been a pleasant evening and a nice week.