By Matt Klan – Emergency Medicine Trainee
Still better than dentistry – a trainee’s perspective on enjoying ED
My first resus shift was about 3 weeks into my ED term, which was my first term as an intern. Around midday, before the evening staff had come to bolster the line, a patient rolled in to resus 4 with an exacerbation of COPD. My consultant and registrar were both with unwell trauma calls and couldn’t immediately help.
We’ll call this patient John, though that’s not his real name. John had a packyear history eclipsed only by his pCo2. John also had a learning difficulty and a speech impediment so terrible as to be completely indecipherable to anyone other than his direct carers, who had sent him in from the nursing home. Communication was not made easier by his terrible respiratory distress and air hunger, nor by his obvious terror.
I guess I knew enough at that point to continue bronchodilators and get some access but didn’t have a whole lot of ideas beyond that, and John was getting worse – tiring of using his whole body to breathe.
I crossed the floor to find the other consultant who was on at the time.
To this very fresh (and pretty average) intern, this consultant’s ability to walk into a resus bay, immediately grasp the situation and come up with a plan seemed remarkable. His aequanimitas was more impressive to me still. I attribute my choice to pursue emergency medicine to this event and to several like it.
John spent a couple of hours on CPAP, the steroids kicked in, and then was able to move to the ward on nasal prongs with intermittent nebs.
The contrast between this encounter and the cases I’d learnt from at university was stark – there was no sequential history, then exam, then diagnosis, then treatment; it felt messy and uncertain and it all happened at once.
It seemed to me then, as it does now, that an emergency specialist is the one who knows what to do, even if they don’t have enough information to know exactly what’s wrong with their patient. That’s part of the reason I like emergency medicine so much.
The other parts are less exciting –
I like to look after very unwell patients, but also after those with less dramatic problems. Cheering up a miserable 2-year-old by reducing a pulled elbow is something akin to magic. I think it’s great to be a generalist even with respect to acuity.
I like to work with a team who isn’t afraid to call each other for help when needed, where stuffy hierarchical structures and delineations are ignored when they need to be.
I like to see untreated pathology when it’s fresh, and treat it with the right tools, used well.
I like to be able to teach what I’ve learned to new groups of junior doctors and students, and to see realisations click.
Generating wellness from your occupation would be easy if it were always so straightforward, but of course it isn’t. The frequent presenters, the unsolvable pathologies, the really sad stories all take their toll.
I complained once to a boss of mine during an end-of-term assessment about a day that had been very heavy with these types of patients, and about how it seemed like we hadn’t achieved anything. She pointed out that without us, their pain would have been greater, and that even if we can’t always remove pain and suffering, we can usually lessen it.
I think it’s especially important to remember that part as a trainee. Our time as trainees isn’t just to memorise the algorithms, get enough exposure to develop reliable gestalt, and learn technical skills; it’s time doing a job that we’ll be doing for the rest of our career – seeing patients and trying to lessen their suffering. Usually we know how, and keeping that in mind can make what we do a lot more rewarding.