11 pm - 7 am

A Saturday night in the county ER can bring out the best, worst and weirdest in people. I shadowed last night (again) for the 3rd time in 3 days. I had been at Hermann for 2 days with true shadowing. There are so many people available to do things there, it is just hours of watching. Very interesting watching, but still watching. The county ER is another matter. There is always something for someone willing an able to do, for example, an arterial blood gas, a rectal exam or a pelvic exam or place a Foley catheter. And throw in a lot of good watching, too.

I guess that I will have to start a secret Dr. Oakes society/fan club in which I collect her toe nail clippings and wear them in a vial on a necklace. She is incredible and seems to have decided to have incredible confidence in me. I feel quite honored and humbled by her attention and insight, but I keep wondering when someone will decide I am just an imposter who happens to have a coat, badge and some doctor toys. It still amazes me that I am able to go up to someone in the ER and say "Hi, (person I have never met before) Let's talk about that vaginal discharge." and then they actually tell me things.

Last night there was a woman who had been found unconscious, brought to the ER by EMS using the "thumper" which provides CPR. It really looked bad, but the entire team really worked hard to stabilize her and eventually she was to be transferred to another hospital for more testing. Majority of places in the world, she would not have a chance, many places in the US she wouldn't due to distance to a facility able to handle her complex problems. But she was lucky, getting very sick in the right place at the right time and having the right people taking care of her. She might never recover, she might be dead right now for all I know as I write this, but the ER staff was able to give her a fighting chance and that is where hope begins.

Hope was ending for another woman who was going to miscarry, sad and in pain but no baby was present during the ultrasound. I got to do the ultrasound and learn how to do that but it was not the happy occasion where we were looking for a heartbeat.

There was also a man who was very altered from whatever he had been ingesting. He had more tattoos than you could imagine and would smile and smile. Until security had to be called. His coming down was not as good as getting high apparently.

So don't drink, don't do drugs, don't ride motorcycles, bicycles or ATVs, don't get pregnant, don't drive or have any fun. But if you do, know where the nearest ER is and hope it is not me coming in to interview you! ;-)

Blog Fail

So I guess that my hope of blogging more will just go down in the annals of a failure. But this week, the kids are at VBS with Grandma and I have some time. Now I should be doing other things, but I thought I would like to update myself for these last couple of weeks. I can officially say a few things:

1. I am an MS2. I passed. I will be moving on up (well actually down a floor) in the fall. I get to look forward to pharmacology, pathology and a mish mash of other classes to prepare me for USMLE Step 1 and life in the wards.

2. Maine vacations are wonderful. I would love to bottle the coolness and views.

3. I do not want to practice Family Medicine. I spent 2 weeks with a fantastic doctor in her clinic. She practices alone, really knows her stuff, was so helpful and kind to me, but I don't want to do that for the rest of my life. That removes one of the possible options from my list. Now if I can't do anything else, it wouldn't be that bad, but it is not a top choice. I equate it to my teaching days of someone failing a test and coming to me to talk about it. We go over all of the things to do to change the direction they are going in, doing homework, taking better notes, coming for tutoring, asking questions, coming to test reviews, lists of resources and often tons of time from me. Then on the next test, they fail, sometimes even worse because they chose not to listen to anything that I said. It can get even better when they blame me for their situation.

I just can't see myself repeating the don't smoke, don't drink, don't do drugs, don't suck down milkshakes and donuts, don't sit on your fat behind all day and expect to be a supermodel who lives to 125 years old. You are not going to put that on me, bucko. I could see the sarcasm, bitterness and resentment creeping in within about an hour.

3. I really liked my peds preceptorship. Kids just put a smile on my face and my preceptor who happens to also be my kids pedi is fantastic. She has a great manner with kids, parents and staff and YOU WILL COMPLY! But she always has the best interest of the kids in mind even if the parents have broken every rule in her book. But she will let them know that! There is a simple gratification in making the kids feel better, parents more relieved and problems solved.

4. I REALLY still like ER. I have shadowed several times this summer and have seen some very interesting things. I have done an ABG in the femoral artery, started an IV, assisted in draining a knee effusion, done a rectal and taken quite a few histories and mad my feeble attempts at presenting. I even kinda diagnosed a guy with shingles. I have worked in the ER overnight twice and if I am able to sleep within a couple of hours of getting home, I am not too worse for the wear. It is also neat seeing the MS3's in clinic and knowing that in just a year I will be there! I have been so blessed to have been taken under the wing of Dr. Oakes, just an amazing clinician, instructor and now in my book, friend. God works in wonderful ways.

I have seen some unpleasant things in the ER, especially since I have mostly been at the county hospital. People in difficult situations made more difficult by the economy struggling with deciding when to seek health care. I again thank my lucky stars for good insurance and the ability to get care when I need it.

I saw the last minutes of life on 2 people. One had collapsed at home and was brougt to the ER receiving CPR and oodles of drugs. He had been unconscious for a while and never regained consciousness at the hospital. His large family was sequestered in "the room" where the news was broken that he had died. I followed along to listen and learn how to do this one day. Never an easy task that can be made worse by accidently changing verb tense from is to was before you want to do that. The other gentleman had tried to chase down someone who had burglarized his neighbor's house. I heard his last words before he was taken to surgery. He was a difficult case that needed to be moved to the OR sooner than later and those few minutes were precious time lost.

But even with all of that, I still love to go to shadow and I am excited about the second year.