Back in the game

So after two fly-by dreamy months in big east coast inner city ED, I've moved out westward and am currently in Overcrowded Understaffed University ED. The patients are sicker, the waits are longer, the traumas more traumatic. The waiting room looks like the aftermath of a war zone. Dozens of moaning, bleeding, vomiting, figures strewn about the chairs and the floor, crouching under airplane-sized white blankets in various states of misery. The wait can be eight hours or more.

One of the doctors reassured me that "if they survive the waiting room, they can't be that sick."

Oh, and students are allowed to write orders, meaning that I'm am actually treating my patients essentially on my own. The theoretical one-to-one student to attending ratio flies out the window when seven trauma/resuscitation cases come in the door at once, every single doctor runs off to the trauma room, and I'm left alone managing literally the entire team's patients for four hours. I do my best to make absolutely no decisions of any importance during those times. Although doing nothing is a bold decision as well when one of the patients is an active GI bleeder, and six different nurses implore me to write orders for pain medications I've never heard of for patients I haven't seen.

Once in a while my attending will pop by and rattle off a list of about 20 things to do that I've never done before. It goes much like this: "Order pain meds for the patients in 43, and 47, whatever you want to give them. Change 41's antibiotic to something more broad-spectrum and then discharge her with a laxative. Order procedural sedation and find the sedation cart for 53, look up how to reduce luxatio erecta shoulder dislocations and be ready to do it, put an NG tube down 37 and lavage him to clear once now and once in twenty minutes, look at 39's x-rays, call ortho, and describe her fracture to them." Then he zooms off down the hall and disappears to trauma-land for another three hours.

I imagine this will be a fantastic place to learn once I get my sea-legs. Right now I feel like I've played a simulator game a few times and suddenly find myself piloting a commercial airline with no backup. I theoretically know what to do but. . .

The good news is zero people died under my watch, I did successfully reduce the shoulder dislocation, my GI bleeder stayed stable, and I actually sent three of my patients home feeling better.

Working overnight tonight, I have to go study my pain medication dosages.