A Day in the ER

Yesterday, I spent my last day of break shadowing with an ER doctor. One thing that stood out at Stony Brook University Medical Center: the ER is absolutely beautiful and clean! Well, it’s not exactly a beautiful, fun vacation spot for the patients and their families. But it is a notable contrast to NYU Langone Medical Center. There, the area was cramped, barely any privacy, and hectic. Most of the time during my shift, I was bumping into monitors, frazzled nurses, and stretchers. Much better and more breathing space at Stony Brook…

Alright, what did I do those 5 hours? First, I visited a patient who came in with shoulder pain. I had the chance to ask for a brief history, get to know her, and ask about her chief complaint. Unfortunately, she tripped over a computer cord, broker her computer, and ended up with great pain in her shoulder. It also did not help that she has osteoporosis, putting her at risk for more fractures. I asked questions I learned in Foundations: “Where is the pain? Does it radiate or stay localized? How did the fall happen? Is there anything you do to alleviate the pain? What makes it worse?” and the like… Oh, she was a lovely woman, the only thing bugging her was the long wait to see a doctor and get pain medications… In the end, the X-ray showed a humeral head fracture; nearby residents could only say “OOOooo, that’s gotta hurt.”

Down the hall, I met with a man bed-ridden with bad back pain. It was not him complaining and acting bitchy, it was actually his wife. Lord, she was annoying. I mean, it’s okay to be concerned for your husband, but really, take a chill pill, be patient, and listen to the doctor. A bit later, the doctor and I walk in to pay a visit, and we see the husband moving about and stretching his muscles, and his bitchy wife laying on his bed with a pack of cigarettes in her hands. On top of that drama, she tells us “My son fell off the chair when he was reaching for the blood pressure cuff. And he was crying all over the place. The doctor’s here now, tell him what happened…” This boy’s a bit plump, maybe 11-12 years old. He kept rubbing his shoulder as if a little bump hurts that much. When the doctor asked him to take off his sweatshirt, he lifts his arm perfectly fine and rather quickly. What the hell? What an attention-seeking, dysfunctional family… When we left, the doctor said “If he wants, we can get a nurse to admit him…” just to satisfy the boy and his mother. Aish…

Other things I did… I saw a pelvic exam. The rotating resident was excellent at teaching and walking through the procedure. This patient was Spanish, spoke no English, just had a baby, is complaining of abdominal pain from front to back, and bloody stool. Yes, complicated… Something interesting I learned was the “Chandelier sign,” where if the patient has pelvic inflammatory disease (PID) and the cervix is touched, the patient will be highly sensitive and in pain. The hands shoot up as if grabbing for an overhanging chandelier. In this case, no such thing happened, so she was clear. But after the procedure, I was like “Ouchies…”

I was able to hesitantly identify a femoral neck fracture for one woman who could not move her entire left leg. Her foot was also slightly everted and there was referred pain to her knee area. I said to the doctor and his resident, “So the medial circumflex artery is at risk!” Doc responds, “And only a first year student fresh out of anatomy will tell you that!”

I think I’ll finally remember the difference between Murphy’s sign and McBurney’s point, because the ER doc tested me when he was feeling the patient’s abdomen. Specifically, he was feeling for tenderness in the gallbladder because she needed a cholecystectomy (fancy medical term for gallbladder removal) for gallstones. I knew what he was feeling for, but 2 signs beginning with “M’s” are bound to confuse me, so I failed on my 50/50 shot. McBurney’s point is actually the point 1/3 between the anterior superior iliac spine (ASIS) and umbilicus, and where you feel for the appendix if there’s tenderness or swelling.

Any drama in the ER? Of course! Right next to the little alcove the residents and doctors were sitting in, a huge commotion broke out. A psychiatric patient broke out in rage and bit the nurse attending him. The nurse came out pissed and her arm was bleeding where the bite marks were. I saw a bunch of nurses and doctors running to the room next door, like how you would picture an emergency room. The doctor I was shadowing, he was a strong-sized man. He went in and came out 5-minutes later with his stethoscope slightly broken, face and fists a dark shade of tickle-me-pink. And you know what they call it in the ER? Code M = Code Man. Fun. Adding a dash of drama in everyday emergency.

I liked my day in Emergency Medicine. This was my first shadowing experience, and I’ve only stepped in a puddle. More soul-searching in days, months, and years to come =)

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