The EM rotation was my fifth rotation, and my favorite one so far! I really really enjoyed everything about this rotation. Some aspects I especially enjoyed was the amount of patient interaction I was able to have, the on the spot problem solving that took place in order to come up with differential diagnoses and orders to place based on the history and physical, and the procedures! I also loved the environment and all of the incredible staff I had the opportunity to work with here at Metropolitan ED.

Some skills that are difficult for me are presentations, and deciding which labs to order based on patient complaints and differential diagnoses. This rotation was the first time I had to give official presentations of patients I saw- in my past few rotations, while I did present patients, it was not as systematic and organized. I realized that I get nervous and often have a hard time organizing my thoughts when I present patients. When typing up an H&P or note, it is easier to organize your thoughts, but when presenting, it sometimes becomes more difficult. I saw that the more I I practice, the better I am getting at presenting. So, I tried to present as many patients as possible in order to get more practice and experience, and did see myself improving throughout the rotation. I am still not perfect though, and I can get better by practicing more. It also may be helpful to me, when possible, to write out what is going on before presenting, so that I can organize my thoughts better that way. Deciding which labs/tests to order is also difficult, especially since after speaking to a bunch of residents about it, I discovered that often it is up to the attending-some attendings prefer doing more thorough workups, while others do not. I did get some pointers though, such as which labs are most important to order when suspecting which diagnoses, as well as the basic labs to always order on most patients, and also got some advice on websites, such as WikiEM, to help with differential diagnoses and testing. I can get better at this by practicing more, looking up when I am not sure of something, and when in doubt, asking a question!

Some types of patients I found challenging throughout this rotation were intoxicated patients. At any given time, there were multiple intoxicated patients in the ED- some were just there for observation until they became stable enough to leave, and others were there with actual medical issues that were exacerbated by the fact that they were intoxicated. It was often difficult to treat them properly and without bias, and show them proper sympathy, especially when they were being extra rude due to their intoxication. They also were often so out of it that they were unable to provide accurate, or any, information about what was going on. For example, I went to interview a patient who had a ring stuck on her finger that needed to come off, and found her unresponsive (her vitals were good, she was just out of it.) I discovered that this was due to the fact that she had taken a large amount of an opioid prior to coming in. It was very difficult to get any sort of history, and it was difficult to properly treat her, both physically and emotionally, especially when she was screaming at us as we tried to help her, and it was clear that she was not using proper senses due to her intoxication. Still, I recognized as a practitioner that it is our job to help the patients and give them proper care, and put that first and foremost in my mind and the way I treated her.

My perspective on those addicted to opioids also changed as a result of this rotation. While I saw a lot of intoxicated patients, I also saw many patients who, after basic interviewing, I discovered they were in a methadone program to get over opioid abuse. It made me proud to meet and get to know people who are taking steps to fix their situation and save themselves and their futures. One of them confided in me that although it is hard, it is important to him to stop his addiction for the sake of his children. I thought that was very admirable and realized that opioid addiction is something that unfortunately many people go through, but it does not make them a bad person, just a person in an unfortunate situation. Getting to know these types of patients helped me overcome my previous challenges and better treat all patients with proper care, respect, and empathy. 

I had many memorable patients this rotation, which made me get a deeper understanding into the nature of people’s lives, the difficulties they live with, our preconceived notions, and how we, as practitioners, can help. One of these patients I saw just a few days ago was a woman who came in complaining of “pain all over.” When obtaining a more detailed history, I understood that she meant that she has myalgias all over her body, and she has a history of lupus and fibromyalgia. Upon further discussion, I learned that she is almost always in pain but usually does not come to the hospital because it usually goes away on it’s own, but came almost as an act of desperation today because she has been in pain for a few days without relief. She admitted to me that she has become increasingly depressed ever since her diagnoses since she is less and less able to care for herself and does not like having to rely on other people to help her with her basic needs. Though in so much pain, she also refused narcotics since she did not want to become addicted. When discussing the case with the attending and resident, the attending stated that often people with fibromyalgia are dismissed as “drug-seeking”, and we discussed how this was clearly not the case with this patient, since she was clearly not even interested in taking the medication she rightfully should have been taking for her pain, and the importance of being non-judgmental and not coming in with preconceived notions about people’s complaints and level of pin/discomfort. I could tell just by speaking the patient that her pain was real, listened, and showed her proper care and empathy over both her physical and psychological issues, both very real. We did end up helping her physical pain, but as she left, she thanked me for respecting her, understanding her, and being there for her on a deeper level.

Something I learned about myself during this rotation was that I LOVE EM! And I am capable of more than I think I am. Going into this rotation, I was nervous. I consider myself to have a more laid-back personality and based on what everyone else told me, EM is intense, fast paced, and not “chill” at all. Though it was definitely fast paced and often pretty intense (we were not officially a level 1 trauma center but I saw some pretty serious cases), I realized that I love that environment because I feel like I am able to do more. I got the opportunity to see so many patients, come up with differential diagnoses, take steps to rule in/ rule out diagnoses by doing on the spot tests such as FAST exams and pelvic exams, and often treat patients and help them go home feeling better. In my interactions, I was also able to spend time listening to patients and giving them proper emotional care and support which is something I am passionate about and find very rewarding. I really felt like I had the opportunity to do so much and really have a positive impact on these patients. I also learned that I love procedures and can do more thank I think. Going in to this rotation, I was determined to “push myself” to do procedures, since I knew that my EM rotation was when I would have the opportunity, and even though I felt nervous about it. When the opportunity to do my first Lac repair came up, I was surprised that I felt more excited than nervous. After performing this procedure, I felt so incredible and couldn’t wait to do another one. Throughout my rotation, I got to do a few lac repairs, I&D’s, POC US/ FAST exams, as well as IV’s and blood draws. Though I did not do many other procedures, I felt like I wanted to, which was something I never expected of myself and was happy to learn about myself.