The Emergency Department: people don’t like being here. It usually means your sick, or injured, or someone you know is sick or injured. The only other reason to be here is because you attend to the sick and injured. As well as the insane, the inebriated, and the incensed. I’m here because I’m rostered to work. My first year as a doctor.
Apparently being a doctor is supposed to be glamorous. Or at least vaguely noble. In books and movies and tv shows, they’re depicted as the egotistical diagnostician, or the heroic surgeon. Or maybe as the compassionate clinician who knows exactly how to break bad news. Often they have a group of wild, crazy doctor friends who get up to wild, crazy antics. They have poignant moments and existential angst. And seemingly endless empathy, or sometimes none at all.
The reality of it is, this is kind of a myth.
Fact: Pop culture has it wrong. Like in any other job, you get all sorts.
Myth: Doctors are selfless and tireless.
Fact: We try and do the right thing but often we have to figure out what this is on very little sleep and copious amounts of caffeine.
Myth: We get paid heaps of money, so it’s all totally worth it.
Fact: The switchboard operator makes more than I do.
I pull myself out of my reverie and regain focus. The computer tells me the patient I have just picked up is bed 8. I spy a large man at the end of the row. He’s talking to someone on his mobile, and I catch the end of the conversation as I approach.
“I have to go, the nurse is coming.” This happens a lot. I don’t take it personally. I think it’s partly because I look young, partly because I’m female.
“Hi Mr Smith, I’m one of the doctors on. What’s brought you in today?”
“The ambulance”.
Patients seem to love this joke. They have this notion that it’s clever, witty, unique. That I haven’t heard it fifty times already. That six of those times weren’t earlier today.
“That’s a good one!” I play along. I have to maintain rapport with this guy. “Can you tell me about your pain?”
“It was in my chest.”
“Can you tell me more about it?”
“It was the worst pain I’ve ever had.”
I try again. “Could you maybe describe it? Was it sharp or dull?”
“Yes.”
Is that even an answer? I shuffle around the papers in his file, try and collect myself. What would House do? No, that’s no good, he’d just have a rant about something that’s tenuously connected to the case then insult the poor man.
“What were you doing when the pain started?”
“I was watching TV.”
“Did anything make the pain better?”
“I took an antacid, like I usually do.”
“And did that settle the pain?”
“Well yeah”.
“So there’s no pain now?”
“No”.
This was evidently going to take a while.
“So you’ve had this pain before?”
“Yeah”
I pause, hoping he’ll elaborate. This is feeling like an interrogation. It’s not meant to. I’m not about to start bending this guy’s fingers back one by one until he spills all. And yet he’s looking at me with concern. I continue my interrogation.
“Any relation to meal times?”
“Now that you mention it, it usually starts after dinner”.
“Any pain in the jaw, neck, arms?”
“No.”
I shuffled the pages in the file and generally tried to look like I new what I was doing. I recall those countless university lectures, the communication tutorials, the stuff about the open-ended questions. That hadn’t worked for me with this guy – he had used the ambulance joke.
“Do you have any other medical problems?”
“No”.
On the side table is a plastic bag filled with bottles and pill packets. Turns out he has medications for hypertension, reflux and high cholesterol. I guess he does have other medical problems.
“Anyone in the family have heart troubles?”
“Oh yes, my grandfather and my father both had a heart attack, and my brother has angina. Been in my family for years, so you can see why I was worried.”
He says this proudly, like some sort of warped heirloom being passed down through the generations.
I proceed to examine him, stare at his plum normal ECG, and garner what further history I can. It’s like pulling teeth.
The blood tests are normal as expected, and his chest x-ray shows everything to be in the right place. Eventually I convince him he’s not having a heart attack and tell him he’s fit to go after giving the usual disclamatory spiel of what to look out for and when to come back.
I check the wait list, click on a name and go searching for my next patient. The old lady looked very unwell. She had dementia according to the short triage note, and so understandably couldn’t tell me anything of use. She had waited to be attended to for five hours. People think that coming in by ambulance means you won’t have to wait. It doesn’t. Patients are triaged according to their condition and it’s level of urgency. If you’re a lowly category 4 or 5, good luck having anyone even cast eyes on you within one or two hours. It’s nothing to do with kindness or caring, it’s just a matter of resources.
Her name is Mrs White. She comments on the nice shade of the curtains. I smile at her reassuringly, ask her if she is in any pain. She continues to stare at me vacantly, then asks for a cup of tea. I mumble something in the affirmative, knowing full well I won’t be keeping my promise. I have to keep her fasted until I figure out what’s going on in case she has a bowel obstruction, or in case she needs surgery.
I decide to call the Nursing Home for a collaborative history. After three rings, the person on night duty answers. I introduce myself, apologise for calling so late, and proceed to ask my questions.
“So was she well during the day?”
“I don’t really know, I wasn’t on during the day.”
“Was she eating and drinking? Any vomiting or diarrhoea?”
“Not that I know of.”
“Are any of the other residents sick?”
“They’re asleep now so I can’t wake them.”
“I understand.” But really I don’t. Her response didn’t answer the question, and I’ve learnt nothing I can use. All I have on this lady is a photocopied page of her regular medications, and her identification details. The ambulance officer’s notes are impossible to make out due to their faintness – why do we even have carbon paper in this day and age? I ask a few more questions, none of which the person on the other end of the line knows the answer to. I think about calling the family members, but it’s late and it probably won’t be of use anyway. Instead I just examine her and run some investigations.
The more senior doctors are tied up with the victims of a multi-vehicle trauma. The resuscitation bays are crawling with players, like some sort of gory stage where a morbid drama unfolds. Amid all the staff members, the equipment, the noise, lie the battered and bruised individuals who were likely doing ordinary things not all that long ago. It’s organised chaos. I just want to run my patient's head CT scan past someone who knows what they’re doing. I think it looks ok. A part of me wants to trust that instinct. A larger, more terrified part of me realises I have minimal experience and could probably misread a hole in the head.
I suddenly realise I have a headache. And I haven’t had a chance to use the bathroom since I started my shift eight hours ago. And I haven’t hydrated. I spy one of those packaged single-serve juice cartons that you only ever see in hospitals or on aeroplanes. I’d kill for a juice. Though that’s against the Hippocratic Oath. What would Hippocrates know about high calorie mass-produced food products anyway? Oh wow, I’m losing it. I try to shake it off. Instead I steal the juice, skull it, and sort out my last few patients.
Relieved my shift is finally over, I head to my locker. As I walk towards the automatic doors, I make a mental list. All the usual suspects had made an appearance tonight: the heavy man with chest pain, the little old lady from the nursing home with a fever, the kid whose parents think it’s at death’s door but is busy tearing up the waiting area. The hypochondriac; the hysteric; the hobo.
I’m tired, and my headache is getting worse. There is barely any traffic now. It’s late, or rather it’s early, and the air is cool. I pull my jacket and keys out of my bag and swap them for my badge and stethoscope. I’m about to cross the road and make a dash for the carpark, but I hear a jangling and then a clink as my keys fall to the pavement. I swear, step back and scrabble around to fetch them. At that moment, a delivery truck roars past, the driver preoccupied with his coffee. It occurs to me that had I not dropped my keys, there’s a good chance I’d have been hit. I’m sure there’s something I should be feeling, or thinking, about life and death and the value of life and the suddenness of death. Absurdly, I chuckle to myself. My only thought is that I narrowly escaped having to go back to the Emergency Department . Well, for now at least. This is just the beginning.
Apparently being a doctor is supposed to be glamorous. Or at least vaguely noble. In books and movies and tv shows, they’re depicted as the egotistical diagnostician, or the heroic surgeon. Or maybe as the compassionate clinician who knows exactly how to break bad news. Often they have a group of wild, crazy doctor friends who get up to wild, crazy antics. They have poignant moments and existential angst. And seemingly endless empathy, or sometimes none at all.
The reality of it is, this is kind of a myth.
Fact: Pop culture has it wrong. Like in any other job, you get all sorts.
Myth: Doctors are selfless and tireless.
Fact: We try and do the right thing but often we have to figure out what this is on very little sleep and copious amounts of caffeine.
Myth: We get paid heaps of money, so it’s all totally worth it.
Fact: The switchboard operator makes more than I do.
I pull myself out of my reverie and regain focus. The computer tells me the patient I have just picked up is bed 8. I spy a large man at the end of the row. He’s talking to someone on his mobile, and I catch the end of the conversation as I approach.
“I have to go, the nurse is coming.” This happens a lot. I don’t take it personally. I think it’s partly because I look young, partly because I’m female.
“Hi Mr Smith, I’m one of the doctors on. What’s brought you in today?”
“The ambulance”.
Patients seem to love this joke. They have this notion that it’s clever, witty, unique. That I haven’t heard it fifty times already. That six of those times weren’t earlier today.
“That’s a good one!” I play along. I have to maintain rapport with this guy. “Can you tell me about your pain?”
“It was in my chest.”
“Can you tell me more about it?”
“It was the worst pain I’ve ever had.”
I try again. “Could you maybe describe it? Was it sharp or dull?”
“Yes.”
Is that even an answer? I shuffle around the papers in his file, try and collect myself. What would House do? No, that’s no good, he’d just have a rant about something that’s tenuously connected to the case then insult the poor man.
“What were you doing when the pain started?”
“I was watching TV.”
“Did anything make the pain better?”
“I took an antacid, like I usually do.”
“And did that settle the pain?”
“Well yeah”.
“So there’s no pain now?”
“No”.
This was evidently going to take a while.
“So you’ve had this pain before?”
“Yeah”
I pause, hoping he’ll elaborate. This is feeling like an interrogation. It’s not meant to. I’m not about to start bending this guy’s fingers back one by one until he spills all. And yet he’s looking at me with concern. I continue my interrogation.
“Any relation to meal times?”
“Now that you mention it, it usually starts after dinner”.
“Any pain in the jaw, neck, arms?”
“No.”
I shuffled the pages in the file and generally tried to look like I new what I was doing. I recall those countless university lectures, the communication tutorials, the stuff about the open-ended questions. That hadn’t worked for me with this guy – he had used the ambulance joke.
“Do you have any other medical problems?”
“No”.
On the side table is a plastic bag filled with bottles and pill packets. Turns out he has medications for hypertension, reflux and high cholesterol. I guess he does have other medical problems.
“Anyone in the family have heart troubles?”
“Oh yes, my grandfather and my father both had a heart attack, and my brother has angina. Been in my family for years, so you can see why I was worried.”
He says this proudly, like some sort of warped heirloom being passed down through the generations.
I proceed to examine him, stare at his plum normal ECG, and garner what further history I can. It’s like pulling teeth.
The blood tests are normal as expected, and his chest x-ray shows everything to be in the right place. Eventually I convince him he’s not having a heart attack and tell him he’s fit to go after giving the usual disclamatory spiel of what to look out for and when to come back.
I check the wait list, click on a name and go searching for my next patient. The old lady looked very unwell. She had dementia according to the short triage note, and so understandably couldn’t tell me anything of use. She had waited to be attended to for five hours. People think that coming in by ambulance means you won’t have to wait. It doesn’t. Patients are triaged according to their condition and it’s level of urgency. If you’re a lowly category 4 or 5, good luck having anyone even cast eyes on you within one or two hours. It’s nothing to do with kindness or caring, it’s just a matter of resources.
Her name is Mrs White. She comments on the nice shade of the curtains. I smile at her reassuringly, ask her if she is in any pain. She continues to stare at me vacantly, then asks for a cup of tea. I mumble something in the affirmative, knowing full well I won’t be keeping my promise. I have to keep her fasted until I figure out what’s going on in case she has a bowel obstruction, or in case she needs surgery.
I decide to call the Nursing Home for a collaborative history. After three rings, the person on night duty answers. I introduce myself, apologise for calling so late, and proceed to ask my questions.
“So was she well during the day?”
“I don’t really know, I wasn’t on during the day.”
“Was she eating and drinking? Any vomiting or diarrhoea?”
“Not that I know of.”
“Are any of the other residents sick?”
“They’re asleep now so I can’t wake them.”
“I understand.” But really I don’t. Her response didn’t answer the question, and I’ve learnt nothing I can use. All I have on this lady is a photocopied page of her regular medications, and her identification details. The ambulance officer’s notes are impossible to make out due to their faintness – why do we even have carbon paper in this day and age? I ask a few more questions, none of which the person on the other end of the line knows the answer to. I think about calling the family members, but it’s late and it probably won’t be of use anyway. Instead I just examine her and run some investigations.
The more senior doctors are tied up with the victims of a multi-vehicle trauma. The resuscitation bays are crawling with players, like some sort of gory stage where a morbid drama unfolds. Amid all the staff members, the equipment, the noise, lie the battered and bruised individuals who were likely doing ordinary things not all that long ago. It’s organised chaos. I just want to run my patient's head CT scan past someone who knows what they’re doing. I think it looks ok. A part of me wants to trust that instinct. A larger, more terrified part of me realises I have minimal experience and could probably misread a hole in the head.
I suddenly realise I have a headache. And I haven’t had a chance to use the bathroom since I started my shift eight hours ago. And I haven’t hydrated. I spy one of those packaged single-serve juice cartons that you only ever see in hospitals or on aeroplanes. I’d kill for a juice. Though that’s against the Hippocratic Oath. What would Hippocrates know about high calorie mass-produced food products anyway? Oh wow, I’m losing it. I try to shake it off. Instead I steal the juice, skull it, and sort out my last few patients.
Relieved my shift is finally over, I head to my locker. As I walk towards the automatic doors, I make a mental list. All the usual suspects had made an appearance tonight: the heavy man with chest pain, the little old lady from the nursing home with a fever, the kid whose parents think it’s at death’s door but is busy tearing up the waiting area. The hypochondriac; the hysteric; the hobo.
I’m tired, and my headache is getting worse. There is barely any traffic now. It’s late, or rather it’s early, and the air is cool. I pull my jacket and keys out of my bag and swap them for my badge and stethoscope. I’m about to cross the road and make a dash for the carpark, but I hear a jangling and then a clink as my keys fall to the pavement. I swear, step back and scrabble around to fetch them. At that moment, a delivery truck roars past, the driver preoccupied with his coffee. It occurs to me that had I not dropped my keys, there’s a good chance I’d have been hit. I’m sure there’s something I should be feeling, or thinking, about life and death and the value of life and the suddenness of death. Absurdly, I chuckle to myself. My only thought is that I narrowly escaped having to go back to the Emergency Department . Well, for now at least. This is just the beginning.
