EM: The difference between you and me

The medical students have started their rotations, so the ER seems twice as crowded nowadays. We've had soon-to-be second years shadowing us for 1-2 days, and we have fourth years doing their ER sub-I's. Apparently at DUCOM, ER is not a required rotation; only 4th years interested in ER can do their sub-I's here. One good thing about having the 4th years around is that they can help see patients, so I see fewer patients a day. The bad part: having to wait in a longer line to present my patients. The 4th years usually present to the 3rd year resident, who then presents those cases to the attending. Sometimes the 3rd year residents present more than one patient at a time, and that makes an even longer wait.

For all the straightforward and uncomplicated patients I see in the ER, there's always a few who insist on being a pain in everyone's butts. Sometimes it's so hard to be sympathetic for them. One homeless guy didn't want to leave the ER and purposely lay in the middle of the street after he was discharged hoping a car would hit him so he'd be rushed back inside. After someone dragged him off the street and put him under suicide watch, he was overheard bragging about how he "played the doctors." Then there was one patient who complained about everything from the bed to the nurses, and when I walked past her room she called out to me and asked me to put artificial tears in her eyes. "I got Sjogren's, ever hear of that?" she said. Yes, I have. Normally I don't mind doing small things for patients that nurses normally do (bringing them food from the nurse's station, giving them urinals and bedpans when need be) but this woman was really demanding. She said her ankle hurt and asked if I could go to the CVS across the street to pick up a special kind of Bengay cream. I told her I was on duty and couldn't go, and she said, "That's the only thing that works for my ankle, and if you can't go, put me in a wheelchair and I'll go get it myself! At the very least I need an ice pack!" The arrival of her nurse saved me from having to respond to that and I was more than happy to leave. The irony of it all is that she herself is a nurse, yet she was being mean to the nurses caring for her. *sigh* Patients come to the ER and feel entitled; don't they realize they're not the only patients and we're short staffed?

Despite working side by side with the EM attendings and residents, there is still a huge gap between me and them. I wear my white coat all the time while the EM residents wear scrubs; a handful of attendings wear their white coats. I continue to want to treat the whole patient, while the ER docs are only concerned with what they need to do to keep the patient alive/stable until they can be discharged or admitted. Even more, the EM attendings definitely favor their own. There was a patient who needed to be intubated and the attending called out that he wanted "an intern." I just happened to be in the area but he didn't even look at me; it was clear he was looking for one of the EM interns. I returned to the station and a minute later Holly (EM intern) came running down the hall saying she wanted the intubation. Later I told a prelim going into anesthesiology about it, and he laughed and asked if Holly needed any assistance (he's done lots of intubations before). I said it was probably better to stay out of the room, and later the attending proudly announced that Holly just did her first intubation with flying colors. Hopefully I'll get my chance at a real intubation in ICU.