1st ED shift
Today was my first shift and I was thrown into the fire. 12 hours at the Mt Sinai ED with the complex computer system, constant private physician consult, and infrastructure in which I am not yet experienced. I worked on the South side with Meika.
I introduced myself as Dr. Curtis for the first time this morning. It felt natural, much more so than the medical student introduction of "I'm Henry, your medical student" or "I'm student doctor Curtis", etc, which automatically discredited your knowledge even before you told the patient you had no clue and would have to discuss things with another doc. This was different. The first impression lent itself to a better alliance with the patient.
At about 1015A I started getting really hungry even though I had eaten cereal and drank my Illy coffee. I kept being consumed by the thought of food until lunch finally arrived, a shrimp burrito. Even after it arrived though, I was behind the 8 ball and had 2 patient H&Ps to enter into the computer so I had to keep working for a while before I could take a 10 minute break. I ate alone in the physician room. Food has rarely tasted so good. I was carniferous.
Things got a little crazy for me at this point and at one point I realized I was seeing 4 patients at once, with one of them being an altered mental status, possibly septic, satting at 87%, but DNI resuscitation. Besides the logistics of the resus room being on the other side of the ED, taking a resus patient was complicated further by the fact that his family was there and one member was a surgeon at the hospital, who was overseeing all the treatment.
There were rewarding moments and good connections with the patients and nurses. For instance one elderly woman with a Klebsiella colonized GU tract stated that I was the best looking doctor in the hospital. When I attached a vent up to a patient I had transported to the MICU, one respiratory therapist said I almost did it right and removed a piece of tubing then reattached the ventilator circuit. I was defended by the other respiratory therapist with whom I had transported the patient and she said I did a perfect job. My first ABG was successful, just not by me. The nurse with me finally tried and succeeded after I tried for 3 minutes and couldn't hit the radial artery on my volume depleted elderly patient. She showed me her trick of holding the slippery artery in place with her free finger and we were cool the rest of the shift. It is all about making a connection with people and building a working alliance, whether it is the patients or your coworkers.
Although I must say in general the ancillary services were incredible, I requested an abdominal CT on one patient and was caught up in tons of other work, thinking that it would be done. At 630PM, the nurse informed me that he still hadn't gone even though I had personally spoken with the radiology intern who said it would happen. I had enough and wheeled my kidney stone patient to CT myself and dropped him off. This meant a signout, as my shift was over at 7PM, which isn't the best form.
Signout went well. I was able to quickly encapsulate the story of my signout and to throw in buzz phrases to let the other team know that he was perfectly stable like "he's had kidney stones for 5 years" and "he had no nausea and vomiting and is well hydrated" and "we are only waiting on the official radiology read of the CT." This let them know that they wouldn't have to treat him as a new undifferentiated patient to figure out.
This was a great shift and reminded me just how exciting and rewarding ED work can be.
I introduced myself as Dr. Curtis for the first time this morning. It felt natural, much more so than the medical student introduction of "I'm Henry, your medical student" or "I'm student doctor Curtis", etc, which automatically discredited your knowledge even before you told the patient you had no clue and would have to discuss things with another doc. This was different. The first impression lent itself to a better alliance with the patient.
At about 1015A I started getting really hungry even though I had eaten cereal and drank my Illy coffee. I kept being consumed by the thought of food until lunch finally arrived, a shrimp burrito. Even after it arrived though, I was behind the 8 ball and had 2 patient H&Ps to enter into the computer so I had to keep working for a while before I could take a 10 minute break. I ate alone in the physician room. Food has rarely tasted so good. I was carniferous.
Things got a little crazy for me at this point and at one point I realized I was seeing 4 patients at once, with one of them being an altered mental status, possibly septic, satting at 87%, but DNI resuscitation. Besides the logistics of the resus room being on the other side of the ED, taking a resus patient was complicated further by the fact that his family was there and one member was a surgeon at the hospital, who was overseeing all the treatment.
There were rewarding moments and good connections with the patients and nurses. For instance one elderly woman with a Klebsiella colonized GU tract stated that I was the best looking doctor in the hospital. When I attached a vent up to a patient I had transported to the MICU, one respiratory therapist said I almost did it right and removed a piece of tubing then reattached the ventilator circuit. I was defended by the other respiratory therapist with whom I had transported the patient and she said I did a perfect job. My first ABG was successful, just not by me. The nurse with me finally tried and succeeded after I tried for 3 minutes and couldn't hit the radial artery on my volume depleted elderly patient. She showed me her trick of holding the slippery artery in place with her free finger and we were cool the rest of the shift. It is all about making a connection with people and building a working alliance, whether it is the patients or your coworkers.
Although I must say in general the ancillary services were incredible, I requested an abdominal CT on one patient and was caught up in tons of other work, thinking that it would be done. At 630PM, the nurse informed me that he still hadn't gone even though I had personally spoken with the radiology intern who said it would happen. I had enough and wheeled my kidney stone patient to CT myself and dropped him off. This meant a signout, as my shift was over at 7PM, which isn't the best form.
Signout went well. I was able to quickly encapsulate the story of my signout and to throw in buzz phrases to let the other team know that he was perfectly stable like "he's had kidney stones for 5 years" and "he had no nausea and vomiting and is well hydrated" and "we are only waiting on the official radiology read of the CT." This let them know that they wouldn't have to treat him as a new undifferentiated patient to figure out.
This was a great shift and reminded me just how exciting and rewarding ED work can be.
posted by Henry NYC @ 11:04 PM
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