ER: Third Day

This afternoon I went to work and reintroduced myself to Dr. Trot. "Oh, did you get the short end of the straw?" he joked. Not really; I chose to work with him because he came highly recommended. He was also known to work at "lightning speed" and I soon saw how true that was. He moved really quickly from room to room so that whenever I finished seeing a patient, I had really search for him or his scribes. I never even knew the histories for half the patients he saw, focusing only on the 6-7 that I picked up. Now that I had an Epic password, I realized just how much Dr. Trot expected me to do. Aside from documenting everything, he also wanted me to order labs and tests by myself and have him approve those later on. There were other times where he'd tell me to order things in rapid succession and I'd have to ask him to repeat himself. "Don't try to memorize these, write them down," he said. Very different from Dr. McC, who said I didn't need to write things down, just do a 45-second presentation of what was important. I prefer writing them down though.

My first patient was a 58-year-old Type I diabetic who initially came for nausea and vomiting but later developed DKA during his stay in the ER. "What tests do you order?" asked Dr. Trot, and I said ketones and ABG. Another patient was a woman in her sixties who hadn't had anything to eat or drink for 8 days b/c she "felt sick," and she looked very jaundiced. Her liver enzymes came back normal, however, and I overheard Dr. Trot ask his scribes what the most deadly cancer was. "Pancreatic?" said one. Yup...painless jaundice usually points in the direction of pancreatic cancer. I also had two abdominal pains. One said his entire family got food poisoning about a week ago but only his symptoms persisted. CT showed a perfed appendix. Another guy had flank pain and hematuria so I immediately thought it was a pyelo. "What about leukocytes?" asked Dr. Trot. Oops, those were negative. "He has chronic hematuria from a kidney tumor," he said. "Talk to him about it." *sigh* Clearly I was not asking any right questions. One woman came in with suprapubic pain and increased urinary frequency, and I was all for calling it a UTI. A beta-HCG revealed she was pregnant (she already had a 12-year-old son and was shocked to get the news), and a sonogram revealed she was 7 weeks along. She also had PID and had to be treated for that. Then an 18-year-old girl came in with flank pain that turned out to be from an ovarian cyst. I had to do pelvics on both. Meanwhile, Adam got to do two LPs, a shoulder reduction, and a paracentesis (which I observed along with Ryan D's wife, who was shadowing Adam's preceptor). When I joked that Adam should give me an LP if he's too busy, he said that it was Dr. Trot that gave him these procedures. -_- Not fair, but I guess Dr. Trot preferred for me to see patients. Besides, I'm sure if Dr. Trot sees me around in the future with nothing to do, he'll give me something to do. My last patient had a bad case of hyperemesis gravidarum (this was her third pregnancy and her previous two were equally bad), and she wondered aloud if she was being punished somehow. I spent about 5-10 minutes listening to how every pregnancy has been so difficult for her and that she would like nothing better than to be happily pregnant like most expectant mothers, but fortunately her faith was sustaining her through her ordeal. *sigh* Rough times.

I left the hospital shortly before 11 pm, without ever hearing back from my jaundice patient (her CTs were done very late), but maybe it's best that I don't know what's wrong with her.