Today was somewhat better. The schedule called for “mega-codes,” which sounds promising, but actually translated into the instructor giving a brief(er) lecture, assigning people to play roles, and then basically talking us through the case while we mostly mimed the correct actions. I guess I was spoiled by one of the hospitals in my old city having some of the expensive, fancy new mannequins, and the training I did on my ER rotation with one of them, where we were expected to carry out every action in order: ie, can’t administer drugs if you didn’t previously think to start an iv, if you don’t put nasal cannula oxygen on the sats will drop, can’t detect a rhythm if you don’t put a monitor on correctly, etc. But it went a lot faster today, so I can’t complain.

One part was slightly disconcerting: The written exam. It was open-notes, and I thought it was ridiculously easy, and wondered why they were even bothering to ask such questions. Only I and the other surgery intern present got 100%. On the other hand, it also turns out that I was the only person who studied the book for more than an hour before class.

Today I found several more of the surgical-specialties interns. We had a congenial conversation about ED-thoracotomies over lunch, and then progressed to exchanging legends about the tempers of various attendings. I’m very happy that so far all the surgery-type interns I’ve met seem decent – as much as one very nervous person can form an opinion of a handful of other very nervous people.

The comic highlight of the day was when one of the paramedics undertook to explain strokes and CT scans to us. We were cracking up with silent laughter at his errors, but we all figured all the other students knew better, so there was no need to say anything out loud. At one point he observed that the CT scan on the screen was noncontrast, which is to say black-and-white, as opposed to colored, and then went on to point to a dot which he averred was a TIA. (For the nonmedical folks, all commonly used CTs are black and white (I’ve seen rare fancy colored MRIs, but not CTs yet). Contrast means whether you inject a radio-opaque substance intravenously, or not; it changes the appearance of blood and blood vessels in the pictures. TIAs are transient ischemic attacks, which means that unlike true strokes, the symptoms resolve over a period of a few hours (24 max); they can’t be seen on CT; even real ischemic strokes are not visible on an early CT.)

Undoubtedly when it comes to real-life, fast action under stress outside the hospital, these instructors were way ahead of us; but it was either painful or funny when they tried to tell us about pathology and diagnostics. Doctors and EMTs think differently. They triage and support the patient till they can get them to the ER; we think about tests and diagnoses.

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