Apologies to my ED friends out there, but I really don’t like the ER. This is separate from the baseline, subconscious surgeon’s feeling that the ER has to be bad because when they call it’s always more work for you. This is: I can’t imagine why anybody actually likes working there, and, like last month, I can’t wait to be off this rotation. Clearly the driving reason behind most of the arrangement of an intern’s rotating schedule is not so much the desire for us to learn general medicine, but the desire for us to learn empathy. I thought I knew how painful it was to be calling consultants and trying to get people admitted all the time. Now I know firsthand; and I swear I will always be polite to the ER people who call me in the future. (Although actually the surgery system is pretty straightforward: if you have a surgical patient, call the surgery intern. Unlike the medicine system at this hospital, where you first call the attending, then the senior, then the intern: triple the work, and not even a pretense that the intern has anything to contribute to the decision-making. Especially crazy since if you call medicine, there’s a 99% chance that the patient will be admitted, so why bother the attending upfront; whereas if you call surgery, there’s a good 20% chance we’ll send the patient home, or punt to GI or medicine.)

I can’t stand not having a definite schedule of some kind. Surgery certainly deals in emergencies; but we have an outline for the day (round, do surgery, discharge patients, evening rounds, go home), whereas the ER is totally out of control. First off, who knows what kind of problem is going to walk in the door – OB, pediatric, sore throat, dissecting AAA, stroke, migraine, need a work excuse, back pain, heart attack. Then, you can’t control when the lab will have results, when CT will get to your patient, when the consultant will decide to call you back, or when your patient will decide to manifest a real emergency even though they came in for something else.

The other interns are laughing at me for having one of my sci-fi paperbacks in my pocket. But we spend altogether too much time standing around doing nothing; and since I’m too annoyed to study, I’d rather be reading something. Waiting for lab results; waiting for CT to show up on the computer; waiting to be called back; waiting to see if the pain medicine will work; waiting for the attending to be free to staff a patient – I hate having to wait and not being able to move on to the next step on my agenda. Here, there is no agenda; the work stretches on forever.

I don’t like the ER. Even the ten-hour shifts and three days off a week will not buy me over. I’d rather work fourteen hours a day, on my schedule, than ten hours like this.

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