Yesterday I was busily catching up on the medical blogs, and discovered a new blog by an ER doctor, Fingers and Tubes in Every Orifice, by Charity Doc. His language is slightly deplorable (not recommended for children), but he is a good storyteller, and has exciting stories to share. Some of his earlier posts relate his reasons for the philosophy of practice expressed in his title. This post about his first patient is quite touching.

As well as jealousy-provoking. He recalls as a third year medical student, fresh on the wards, being assigned a patient at the VA: do a complete history and physical, write the orders, and report to the senior resident, and then be the main caregiver for that patient for the rest of his stay. (And I wish I could meet an internal medicine team which does its own chemo and radiation for cancer patients!) That’s what the interns get to do now. I wish somebody would let me have that much responsibility at the end of my third year. Ahem; stop drooling, Alice. After I dried my eyes, I decided to go looking around the local ER, in hopes that my very favorite doctor ever would be on duty, and let me have another crack at pretending to be a doctor.

She was just back from vacation, and working in the Urgent Care, which means not urgent at all; in fact, nothing happening. So she sent me over to her colleagues in the main ER. Also nothing happening. I swear, I must have mentioned my intention too loudly, and my white luck preceded me to the ER. The doctors were nice, but there were only two nursing home patients; who did manage to have two cases of pneumonia and two UTIs, while being completely free of the classical symptoms. The most promising patient was a schizophrenic with a chest stab wound; but she was hardly even bleeding. The wound was somewhere near the top of her sternum, maybe even right above it, but the doctor took one long in the general direction, and sent her off for an Xray and CT scan before he would even examine it more closely. His reasoning was that if there was anything seriously injured, she wasn’t immediately exsanguinating, and he wanted a picture before he touched it; and if nothing was injured, he could just sew it up without trying to tell how far in it went. I’m telling you; just think of all the vital structures in that location, and all she needed was a few stitches. EMS ought to hire me as a mascot; nothing happens when I’m around.

I will be very curious to see how this works when I have a proper rotation in the downtown trauma center; no doubt the same number of tragedies will occur, but not on my shift. This sounds like I must be very bloodthirsty, but there’s a serious side to it too. There are a number of serious medical crises, which other students have been at least on the fringes of, and I’ve never seen. No real seizures, no serious asthma, only one actual heart attack, no recent strokes, and the list goes on. Those are all basic things, things you would hope that every doctor would have an idea about, no matter what specialty they’re in. Not me. What bothers me most is, I’ve not yet had a patient die, or been present at a death, even on call. I really am not looking forward to having my first patient die when I’m really and truly responsible. Other students had codes every other call, and had two or three patients die on their service. That’s not nice, but I don’t expect to be able to keep this up for my entire career. I feel like I’m missing some fairly key elements of basic training here, and no one knows it, or can do anything about it. However, I’m not concerned enough yet to sign up for an ICU rotation at the VA, which is the only way I can think of to guarantee being around seriously ill patients.

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