Night in Emerg
Yesterday I had my busiest night in emergency so far. The department I am doing my elective in is divided into two parts, each with its own staff physician, usually a resident and, lately, me. One part is more ambulatory cases: things like lacerations, minor muscular skeletal, minor abdominal complaints (at least as far as can be determined at triage). The other side gets the more major cases: resuscitation, possible cardiac or stroke, older more complicated patients, people who are likely to be admitted or at least need a consult. I was on the later last night.

So far I have preferred the ambulatory cases. They may be more minor, and sometimes there is nothing that can be done. [Three days of sore throat in a 27 year old without a fever or other sign of systemic disease is going to get a throat swab (at most) and a push out the door.] The only skill needed in those cases is the ability to explain that the need for antibiotics is not proportional to the time spent waiting. But stitching someone up, solving a defined problem in a single shift is satisfying. At least there is resolution.

I have been unlucky on the major side. The cases I have been getting are ill defined, inconclusive and, in many cases, not real (the overdose vs seizure later admitted that they faked the whole thing for a love interest). Last night was busy and I had the real feeling like I was working through medical problems to the benefit of the patient. This is what drew me to emergency in the first place. History - physical exam - differential diagnosis - thoughtful use of tests - diagnosis and plan.

Don't get me wrong. I am not one of those students that prays for a major accident or the acute onset of a dramatic deadly condition just for the sake of my learning, or the adrenalin rush. I would just as soon have your chest pain be some minor angina rather than a dissecting aorta. I don't wish for more sick people in emergency (at least I try not to). But I was starting to get a little sick of the people that were showing up at emergency because they felt that their family physician was not listening to them about the arthritis they have had in their knees for the past 5 years. Especially when it takes 20 or 30 minutes, and three stories about their grandchildren, before they tell me that.