First Day on the Job

"I am always ready to learn, although I do not always like being taught."
-Winston Churchill

I have now survived five shifts in the emergency department (ED), and I'm a little bit shell-shocked.  To say that the experience has been overwhelming so far is such a grotesque understatement that I'm reading over what I just wrote and laughing.  Or maybe it's just that I'm exhausted.  Or both.

My first shift was last Saturday evening from 4 PM to 2 AM, which actually meant 4 PM to 3 AM.  I knew I was in trouble as soon as I walked through the front door of the ED and saw the waiting room.  Every seat in the place was filled.  Not only that, but it was chaotic in there, with children running around, a dozen different cell phone conversations going on, and one person in the corner puking into a bucket.  I resisted the sudden urge to turn around and run back out the way I had just come in, took a deep breath, and swiped my badge to go inside.

The adult ED at the University campus is organized into two patient care areas called North Pod and South Pod.  Each pod has about 15 rooms, plus the capacity for another dozen patients or so out in the hallway.  The South Pod, where I was working that night, was utter pandemonium that made the waiting room look calm and sedate in comparison.  On my right was a drunk patient shouting at his nurse, and across the hall from him was a schizophrenic patient going on about some conspiracy or another to anyone who would listen.  A third patient was holding his stomach, crying and moaning.

I went into the physicians' charting area and introduced myself.  One of the other residents showed me how to log in to the computer system, and I picked up my first patient, who spoke no English.  Okaaaay.  There are on-site interpreters for several languages at UMass, but this wasn't one of them.  So I had to use the interpreter phone, which was actually pretty cool.  You just dial up, tell them what language you want, and presto, they connect you to an interpreter in that language.  It worked very well.

The rest of that first night was a blur.  I duked it out with the electronic medical record, debated whether it was ok to give Tylenol to a patient with abdominal pain, and once I decided that it was indeed ok, struggled to figure out what dose to use.  One of the seniors asked me to call the gastrointestinal (GI) medicine fellow, and when I did, I couldn't answer most of her questions since I knew almost nothing about that patient.  The fellow immediately figured out that I was a new intern, kindly told me what information she needed, and asked me to call her back once I had it.  I don't think I've ever felt more incompetent or idiotic than I did that night.

When I finally left at 3 AM, the waiting room was even more crowded, which I would not have thought was even possible.  I ran outside, where it was fairly calm and quiet, and took a deep breath.  Phew.  Just two years, 51 weeks, and six days left to go....