14 September 2010

Night Shift

"When everybody else is getting out of bed
I'm usually getting in it
I'm not in it to win it
I'm in it for you"

Train. "If It's Love"

My first night working in the ER was fun. It was SO strange waking up late and going to work at 6 pm when my roommate/ the rest of the world was coming home. I hit SO much traffic getting through Dallas, yuck!

Highlights of the night:

Taking care of a cute 5 year old who "my head hurt so bad that it made me cry on the bus ride home." Awwww….poor kid. He had a fever and sore throat. I had no idea how the headache fit in though. But my preceptor told me little kids don't know how to say headache. But their head hurts when they have a fever. We checked him for meningitis, and there were no signs, so we treated him for his sore throat. He was such a good sport about us looking in his ears and throat. I was so impressed by the way, even though he was obviously not feeling good, he sad up and let me listen to his heart and lungs. I told him he was such a great, big boy.

His mom told me I must have kids.

When I told her, no not yet, she said, "but you should have kids, you're really good with them!"

Which made me smile, and say, "maybe one day, but not anytime soon." And walk out of the room feeling better about being able to examine kids.

My preceptor also told me I was doing a great job. She told me I had skills that she hadn't seen in some of her students getting ready to graduate, and she was really impressed by me. Sweet. Maybe I am learning a little bit!.


Night 2 I worked with the same preceptor. She gave me a bit more freedom, letting me see the patients, write them up, prescribe meds, and then discharge the patient. If I got stuck on my diagnostic plan, I would ask her about it. And she always had to sign off on the prescriptions, which is good, because I don't know a lot about meds yet…

The night was long. We had SEVERAL (more than half!) of our patients come in with abdominal pain. Which is usually a longer work-up. Which is ok, but it's hard when someone comes in complaining of the same belly pain for 6 months and then they pick tonight, at 3 am, to decide it's an emergency. Really?

I had a hard time staying enthusiastic about seeing patients because my preceptor was getting tired of it, so there was a lot of exhausted energy floating around. But we had really great nurses working with us (the pelvic room was ALWAYS set up fully and stocked for us) so we toughed through it.

We had a lady come in around 4 with a big wrist lac (short for laceration, which is just a fancy name for a big cut). I got excited about sewing it up, but after numbing her up and checking to see if her tendons were intact, I found out one was severed, which means we had to call the hand surgeon.

Which is ok with me, she had 5 kids with her in the room (all telling her to be brave, it was precious) and I wasn't looking forward to sewing her up because she was so scared.

Then we ran out of patients around 5 am….lame. But I got to get some extra sleep, which was MUCH needed!


Night 3 was lame. Basically, it was Saturday night and busy. I got to work with 2 NEW PAs when I got there which was cool, but I didn't really know who to report to or what to expect. I did get to sew up a leg on my own and then I&D an abscess on a screamer…

But around 1am they left and 2 doctors replaced them. The doctor I worked with before told me she was "too busy" to have me work with her, so she had me present to the other doctor. He was a great teacher, but he expected me to know more than I did, and he didn't want me to write up anyone. And he saw EVERY patient right after me and then got his own history. Kinda lame. I did get to splint someone, watch a girl get staples, and I&D another abscess though, which was neat!


Night 4 was cool again. I worked with the same preceptor (a FNP-C) that I worked with the first two nights, so we started out with a level of trust. She knew what I knew, and I had a set of expectations to live up to.

I saw a REALLY sick girl with pneumonia. And then a sick boy with the same thing. They were both so small and sweet. I called the little boy "buddy." But he said, "My name's not Buddy.  They call me Fat Buddy." But he wasn't fat.  So I'm not sure why, but either way, it was adorable!

Then I saw some abdominal pain (everyone, it seems, has abdominal pain.)

I watched my preceptor glue a 4 year old back together, and he was precious. SO brave (he didn't cry once!) and so cute. I had to give him a high five on his way out (and we gave him an ER popsicle!)

Then I tried to glue a little 4 year old girl back together. Except her Grandmother thought she should have stitches (for a 1 cm cut…) So I educated the Grandma on why glue was a better option (less painful, less numbing for a kid, no needles, faster) so Grandma let me do it. And then the kid screamed when I cleaned up her finger (I used betadine, which doesn't even sting!) So Grandma yelled at me for not numbing her up. BUT WE NEVER NUMB people we glue. And so I educated Grandma about numbing. Whatever. The kid was fine in the end (she probably didn't even need glue because her cut was so small).

I saw a girl at 3 am with a 4 day history of "seal-like, barking cough." Those were the words right out of her mother's mouth (which rang bells in my head, like she read the notes I studied for pedi block!).  I'm not sure why it was an emergency she needed to come in at 3 am for, but we diagnosed her with croup, and sent her home with steroids.
My preceptor wanted me to staple an 11 year old, but since the 11 year old was a girl, she let me stitch her since the wound would heal prettier. My preceptor told her she was lucky to be a girl so she wouldn't have a scar. Really though, she was lucky a student was following my preceptor, because I don't know if my preceptor would have slowed down long enough to stitch. My preceptor told the girl that I would stitch her, and that she could give me an F if I didn't do a good job.

I had forgotten about that, but when I was finished, the girl told me I got an A+. Sweet!!

At the end of the night we saw a funny pregnant lady. I won't get into the story except to say that now every time we have a pregnant woman, they will get a pregnancy test BEFORE we do any other tests on them J


Overall, nights were cool. I did hit more traffic than I do for day shifts. I didn't see a lot of different stuff though. And now I realize that I'm becoming jaded.

I've been taught to always walk into a room on the patient's side. Which I still do, but now there are a lot more things that push me away from believing the patient.

I've learned what a true emergency is, and what isn't. And I've realized, that most of the ER stuff I see is really "Indigent primary care" instead of EMERGENT. Which is a learning lesson itself, really.

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