One memorable patient I will carry with me is an unidentified man who was found unresponsive in his car. His initial rhythm was asystole, and CPR was started on the field. ROSC was obtained prior to arrival in the ED, but he lost his pulse again upon arrival to the trauma bay. We resumed CPR, and eventually brought him back. However, the patient had fixed and dilated pupils, which led us to believe he was brain dead. This case was tragic in many ways. For almost an hour, we did not know the identity of this man. He did not have any source of identification on him, nor were we able to have any way to reach out to his loved ones. Eventually, his family did find their way to the hospital, and visited him in the ICU. In his CT scan, he was found to have a severe SAH; then we had learned that overnight he had gone into cardiac arrest again and was unable to be revived. Another aspect that broke my heart was wondering what was going on in the patient’s final moments before he lost consciousness. Was his status deterioration quick? Did he have any idea his health was under threat? Was he in pain? What did he have planned for the night? It saddened me to think he was alone and dying, and that we may never get answers to these questions.
This rotation had similarities and differences with my other rotations. There were the patients who came in with common complaints which I have come across prior. For example, those with lower back musculoskeletal pain commonly seen in my Family Medicine rotation; those with a possible fracture as seen in Ambulatory Medicine; and vaginal bleeding in pregnant women as seen in my OBGYN rotation. It was great to see some overlap in the types of cases, which I believe help me better practice my history taking in them. What differed from my other rotations was the severity of cases that may arrive in the ED. The complaints that are more acute and stressful to the patient, end up being seen in this specialty. For example, someone with a small laceration on the arm may walk into Ambulatory care, but if that laceration was extremely deep, with unstoppable bleeding, and the patient experienced a loss of movement or sensation, they would most likely elect to go to an ED.
Working in this ED showed a different way of managing patients. I was used to how Family Medicine worked to find out all of patients’ problems and addressed them. However, I learned that this was not the goal in emergency medicine. We need to rule out life-threatening/altering and limb-threatening differentials. After that, patients were cleared and sent home with referrals to follow up with outpatient specialties. For example, there was a young patient who came in with anemia and lower abdominal pain. A stool guiac was performed on the patient, which turned out positive. I was amazed that since the patient was not in any distress, did not have any comorbidities, and her vital signs were stable, she was simply discharged and instructed to follow up another day with GI. It was shocking to me, since after hearing about positive guaiacs in school, I felt pressured to find out the source of the bleeding.
Prior to this rotation, I had my sights on working in surgery. However, after this rotation, emergency medicine was making its way up to the top 3 of my list. I hope that my preceptor and colleagues saw that I was enthusiastic to learn about this specialty. The work environment was exciting, and the staff added even more to the experience with their love of medicine. At first I was anxious about the rotation, since I could not predict the next patient and scenario that would walk through the door. I was nervous that patients coming to the ED “on the worst day of their life” would not want to talk to students, let alone get procedures done by students (ie: IV, foleys, head staples); however, I was pleasantly surprised by most of the interactions I had. After introducing myself as a student working in their medical team, most of the patients were happy to be seen and willing to work with us.
