For June and July, I was in a rural ER, working as a fourth-year student. It was pretty flipping awesome. Here are some highlights:
The Good:
- I did so much suturing. I sewed every day. Hands, arms, legs, faces; old people, tiny kids; everything from tacking gunshot wounds closed for the trip to the big city for surgery, to closing up messy lacerations from biking accidents.
- I learned an enormous amount about management. Third year the focus is slightly more on honing your history-taking and diagnosis skills, so it was pretty invigorating to start really focusing on when to get a CT vs. an x-ray, when to admit vs. discharge, and some of the specifics of prescribing.
- I saw some decent trauma and a lot of drugs. Interestingly enough, I was never on shift when any of the really serious stuff (stabbings and such) came through, but what I did see was plenty for a beginner like me. I'll spare you the gory details, but man, people find a lot of
The Bad:
- Every doctor at this hospital worked 24 hour shifts. I was allowed to choose my own hours, so I started out doing 12-hour shifts, then had to cut them down to 10-hours so I could study more for boards. By the end of the month, though, I was routinely working 13-14 hour shifts as well as commuting 3 hours back home a couple of times a week. It wears on you.
- I got run off the road in the middle of the night by a cow. It was terrifying. I'm so thankful I was able to avoid actually hitting that enormous thing, and thankful that when I ran off into the adjacent field I didn't hit something or flip or whatever and damage myself or my car. Stupid cow. When I told my coworkers the next day, they were horrified. I guess people die from that. Cows are HUGE.
The Facepalm:
- Sometime during the first month, a patient came in with a dislocated little finger. I stood outside the room as my attending demonstrated on my hand the grip I would take and the vector of my force to put the joint back in place. Sounds normal, right?
I almost passed out.
Joints are a definite weakness of mine. Fluids, fractures, ears, feet - no problem. But joints. Joints fill me with a visceral dread so deep that apparently my body can't handle it, and I start to vasovagal. I didn't even put the finger back in place. I watched, nauseated and weak, as my attending did it for me. I practically had vapors, for goodness' sake. I still can't think too hard about it.
- You know how when you pick up a baby out of a carrier/ carseat, it's normal human impulse to lift the child way up above your head so they laugh and squeal? It's fun and harmless and everyone enjoys it. Unless you don't realise there's a metal lamp hanging above the childseat. I was mortified. Mortified. M-O-R-T-I-F-I-E-D. I can't even tell you. The mother was really nice about it, all, "Oh, babies are tough! He's done way worse to himself so he'll be fine in three minutes!" but it took me a while to stop hyperventilating. What if I knocked his brain about and he lost his ability to enjoy dense poetry before he can even appreciate what he had? What if I slightly malformed his skull so he can't ever have a buzz cut because he'll look funny? What if he grows up with a lamp phobia and never knows why?! Horror!
I mean, I'm sure he's fine.
Conclusion: Man, ER medicine is cool stuff. I'm liking the blood and adrenaline, you guys. And I actually like the small ER I was in, where I could personally keep track of all the patients in the department and know what was going on at all times. It felt more like running things and less like being a little doctor cog in a big hospital machine, and part of the reason I wanted to be a doctor in the first place was to be in charge. And once you get a certain distance outside the big cities, rural ERs see all of the trauma and sickness and craziness that the urban ones do.
