2 for the price of one… 2 for the price of one…

Yes indeed, you will be getting multiple entries today, mainly because the internet is having a funny old time of it, and doesn’t want to work, so I’ve been typing it up, just so I don’t forget it all, and ready to upload when I can!

So, it’s still insanely hot here, but all that is of no consequence, because I spent twelve hours in the ER, and didn’t leave the building once. I turned up (rather nervously) at 6.50, ready for handover (“rounds”), and met my lovely resident, who I intended to follow all day, not being all that familiar with what is expected from American doctors.

How wrong I was.

I was assigned to the back part of ER, or Gulf ward. This deals with medium emergencies, for example chest pain, diabetics with high blood sugar, and unfortunately a lot of genitourinary problems…

So today, I saw (in no particular order) epidydimitis, stomach pain, back pain, chest pain, hyperglycaemia, vaginal bleeding, threatened miscarriage, epiglottitis, dizziness, and the list goes on. That’s quite a lot of patients! There are 12 beds in the Gulf ward, and a lot of the time at least 75% of them are full. It’s busy, very busy.

I followed the resident or the junior doctor for the first two or three cases… and then off I went (horrifically nervous), and took my first “H&P” – history and physical exam – which needs to be quick but thorough, and the exam needs to check all the systems – heart, lungs, abdo, muscles, nerves, etc. Straight out, present to the resident, who then says “ok, so what do you think?” So I make some suggestions, and say what tests I think we could do. The exact response I got was… “ok, off you go then”. So I was ordering tests, getting consults from any and every speciality. Wow. That’s more responsibility in one day than I’ve had in three years back here!

It was fantastic though. I was actually a proper doctor all day!

What has really surprised me is the difference in tests. I’d say I sent about half my patients off for a CT scan, and they were normally gone for the test before I’d finished writing my notes. Crazy quick!

For routine tests – blood tests & urinalysis – I just had to order them and they’d be done by the (absolutely WONDERFUL) nurses. What intrigues me is that urinalysis (one of the quickest and easiest tests… just dip a test strip into some wee and check it against the chart provided) is always sent off to labs, and yet when I did a high vaginal swab, I had to go look at it under the microscope myself, which we really don’t do here.

A twelve hour day passed pretty quickly though, because you are always busy. The worst bits are when you’ve written everything up, done all your tests, and you’re just waiting results. There’s nothing you can do, and so you do end up sitting at the desk for a while, which is rubbish, and I imagine really annoying for the patients (actually, I know that it’s really annoying from being a patient in A&E!).
It got to 7pm, and we went for rounds again, handing over to the night staff. And then blessed freedom! I walked outside for my lift, and my goodness, the heat HIT me like a… thing that hits you. It was SO hot, and I had completely forgotten about it, being in the lovely, temperate ER all day.

Incidentally, LSU (Lousiana State Uni) , the university I am affiliated to for this placement, is in the finals of the college baseball championships. This doesn’t sound massively impressive, until I tell you that ESPN (the major sport channel) is covering it for about 3-4 hours a night. The final is “best of three”, and LSU are playing Texas (the reigning champs). Last night was the first game, and we were losing until the very end, when it went to extra time and we won! Tonight is the second game of three, so we either win and take the championship, or lose, and have to play tomorrow. We shall see…