Notes from a Medical Student:

Deja vu

There's a feeling of déjà vu as I walk through the sliding double doors. The sounds, smells, and sights remind me of times long past. Nurses and medical technicians move past me quickly carrying IV equipment, EKG machines, monitors, blood, and paperwork. I see the small rooms, some curtained, others not. As I look to my left an older gentleman lays on the stretcher, his Sunday best on, clutching at his heart. On the right, a thirty something female lays holding her right upper abdomen. I hear the moaning, calls for nurses, orders being yelled across the room, and the constant 'beep' of a monitor somewhere. In this sea of chaotic order, I feel strangely at home.

I had two decades on this earth the first time I laid my eyes upon the emergency room. I was still in college, studying Greek, Latin, and Philosophy when a friend told me about a job he was applying for at the local emergency room in Cincinnati. It paid well, sounded fun, and already I was thinking how cool it would be to say I worked in an ER. Of course, this was at the height of the TV show. The job was as a medical assistant, patient care assistant, whatever you'd like to call it. I would basically be a jack-of-all-trades. The first day we met the nursing supervisor, interviewed, and then left for a tour of the ER. The double doors swung open and suddenly I was immersed in the chaos. Physicians running quickly past me, nurses kneeling with needles in their arms, and clerks answering phones with rapidity while cross checking paperwork in front of them. I remember thinking that I would never get the hang of this, that this might be too much for me. Four years later I started medical school, leaving the ER which had given me my baptism of fire into medicine and my niche in both library and laboratory for two years.

Now I'm back. Not to the same ER, but nevertheless it feels the same. Oddly, despite the whirl of movement and work, I'm calm, a feeling of satisfaction moves over me as I stroll into my first patient's room for the day. Then the difference strikes me. Instead of running to get an EKG machine, getting paperwork ready, or grabbing an IV starter kit, I'm standing here, white coat on, trying to figure out what's going on with this thirty something female holding her right side. I run the differential. Cholecystitis obviously, but I'm also considering hepatitis, pneumonia, and ulcer. My thoughts run over the pointed questions to ask.

"Have you had any nausea or vomiting?" I start. "Yes a little, I vomited yesterday twice and, OUCH." The IV finds the vein quickly, I watch for the flash of blood, and quickly fluids are running. Vomiting, nausea, right upper quadrant pain, some increased severity to food intake. I'm confident in my differential. As I start to walk out the room, she mentions suddenly, "I've had some discharge and lower belly pain too." I stop… suddenly everything's changed. This is what I learned after years in the ER. Just a slight phrase, a word can change the way you see a patient, the picture, the process. It's what keeps you on your feet. Because beneath all that obvious history and physical exam, sometimes something very sinister and unsuspected is waiting to declare itself. By then you might be too late.

Before the night is over, we have a lull. These are transient, and must be appreciated for as long as they can be, because the storm is always coming. As we sit back and enjoy it, the doors open swing from waiting room. An older gentleman sits in a wheelchair, clutching his chest, sweating. As we lay him down I start moving quickly, grabbing an IV, cleaning the arm, and finding the vein. Retract needle, place lock, draw blood, secure with tegaderm, and flush. I do it without thinking, without pause as he starts to tell me about that elephant sitting on his chest. Later, the nurse pays me a compliment on my rapidity with the IV. "I've had a little practice with it before," I answer.