Life in the ER

Life or limb, surgical or medical, urgent or emergent. Life in the emergency room is all about making critical decisions in the space of a few minutes, if not seconds. I might not be cut out for a career in the fast lane, but I sure had fun running around the emergency department these past two weeks. Thank you for the opportunity!

The constant flux of clerkship

I’m writing this blog post the night after my first 34-hour duty in The Medical City’s Medicine Department floors. It’s only been two nights since my last duty in the ER, but it already feels like forever. I’m dead tired.

Clerkship is a constant flux of identity, responsibilities, and schedule. I feel like I was just getting used to the rhythm and culture in the Emergency Department, and now we’ve been whisked off to the 4th floors and above. More than anything, it might be the emotional stress that breaks you.

(I haven’t been home in over a month. Cries.)

Public versus private hospitals

Literally the very first thing I thought upon seeing the ER was “wow, so much space”. Back in OsMak, patients were jammed in single beds or wheelchairs, which would spill out into the hallways outside the ER. There was no room for patient companions, or any kind of patient comfort.

In The Medical City, even during the busiest hours, every patient had a bed, which could be closed off by a partition. Saucy.

Everything’s also much fancier! You can’t approach the patient with your materials and equipment all over the place. There are alcohol stations near every bed. The ECG machine comes with a keyboard. The one-use tourniquets are practically disposable.

…and everything’s also more expensive! Hats off to public hospitals, but at least they cover a big chunk of the costs. In contrast, private hospitals will grind you and your wallet to dust. I saw a lot of patients get discharged against medical advice due to financial constraints.

ER highlights

I honestly feel way too tired to write up something that’s more coherent and synthesized. Very briefly, I love (a) the fact that we got to have a lot of patient interaction, from interviews to procedures, (b) the comfort of the lounge, (c) the seemingly unending supplies, and (d) the people.

Some days were less bright than most, but they were all good teaching moments. I remember two consecutive night shifts when I kept ‘uptriaging’ patients from urgent to emergent, thanks to progressive DOB, sudden SVT, et cetera. Good times.

(Nurse Ray), me, Faye, Dr. Hermo, Intern Don, Bettina, David, Migui
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It’s the PM gang with Dr. Hermo and Intern Don! The hospitality and warmth of other people is a big part of surviving the abrupt transitions of clerkship. Thank you for holding our hands.

(Specifically, thank you to Doc for literally being there for my first ever DRE and to Intern Don for saving me during my first ABG attempt!)

Ugh I guess FamMed is still a rule in. (The non-urgent is headed by FM consultants.)
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Selfie in the non-urgent! I took this photo at like 3AM, which was the only time there were finally no patients (they started coming back around 4AM). I’m pretty sure the sudden night shifts did some serious damage to my body. I’m yawning just thinking about it.

Big thanks to the Emergency Department for trusting us to be the first-line in the non-urgent and urgent sections. We’re slowly honing our clinical eye. Thank you to the patients for trusting us as well.

The gurney’s tougher (and cooler) than it looks.
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We had several SGDs during the two weeks in the ER. One of them was learning to load and unload an ambulance. Fun!!!

Call LIFELINE 16-911 in case of emergencies.
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Emergency medicine wasn’t really something that was on my radar before clerkship (and it’s still not the top on my list). But I think it’s really cool how emergency medicine has innovated when it comes to non-traditional practice and even equipment/infrastructure.

Intern Mikas, me, Faye, Jesse, Stephen
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The two weeks of the ER rotation is divided into two. One week is spent on the night shift (7PM to 7AM), and the other week or so is spent on the day shift. Many people transition in and out of your group. Got lucky enough to spend a shift with these OG duty mates (plus Jesse).

Shoutout to Faye! In Cafe France during one of my cashless days.
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It’s been only one month but I don’t think I would have survived without my duty and LEC groupmate. Thank you so much for being a familiar face no matter where we go or do. (And thank you for letting me hitch a ride back home after every shift.)

Happy birthday bro!
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My brother decided to welcome his birthday with a midnight celebration. Unfortunately, I was still on the night shift. Instead of eating plates of crispy pata and baked seafood and aglio olio pasta, I had to focus on the flow of patients at the ER. I muted my phone.

This level of life versus medical school is on another level. During the first three years of medical school, I always made it a point to go home during the weekends even when it was inconvenient. Now that I’m a clerk, I can’t even go home even when I do have the time because I’m so tired –and also because of our Saturday Financial Management classes. I miss my home.

Thank you to my bro and the rest of my fam for having a catch-up belated birthday celebration with me. I think I still won’t be able to make it in other important days in the future, but I promise I’ll make up for it someday!

The people are the biggest highlights! Special shoutout to our kind interns Leslie and Benjhoe (TEACHING US THE ROPES), and to our awesome nurses huhu. Nurse Jheric and Nurse Ray, thanks for making that first (?) night shift fun!
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As with any rotation, the best teacher is experience. And more often than not, that experience is guided by seniors and doctors who were once clerks too.

A big shoutout to nurses Hannah, Ray, Eggai, Jheric, Jeff, Paul, Roxil, Steven, Vince, Joan, Joyce, Angela, Kate……… okay that’s a lot of people to name. You guys know who you are! We were 100% inspired by your collective competence and humor.

Thank you to the IM residents making their rounds, to the interns for answering our clerkie questions, and to the nurses for being so stellar and funny. Thank you to the EM consultants for being great teachers and role models. Thank you to the entire Emergency Department for making us feel welcome! See you around!

xxx

All future physicians need to be competent in the must-knows in acute care. In an emergency, it’s never about getting the diagnosis right or sticking to the textbook rules. It’s about saving a life. Sometimes that means stabilizing the patient without knowing the exact disease, or even nurses calling out doctors for questionable orders. The point is to provide enough relief that the patient is well enough to see another day (and another doctor).

Now that I’m in the wards, it’s a whole different matter. Time to rest before the 7AM shift tomorrow!

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