Friday, May 15, 2009

Same Same But Different

I wonder sometimes if I really do in fact like rural emergency. I always thought I did, and always thought I would go into emergency medicine when I finished MD school.

But these last few months I have been questioning that decision. I really like actual, acutely ill patients, problem solving the mysteries that collapse on the triage desk. But what I don't like is the mundane, CTAS 4 and 5's that come into emergency departments on a regular basis. The worst part about the sore throats and narcotic seekers that come to emergency is that they have to wait a long time because they are NOT EMERGENCIES. So by the time you assess them in the department they are hissy and pissy because they have had to wait. And rightly so (the waiting part, not the cranky part).

So the cranky jerks who are abusing the system are the ones that I have to listen to whine all night.


I just don't know if I want to do this as a career anymore.

In this place I am currently working, several docs have just left town, thus leaving hundreds of orphan patients. There is no one in town accepting new patients and no walk-in clinic. Hence my current contract not in ER but in a glorified clinic. I can't blame people for having to access health care in the ER because there is no where else for them to go, in fact I feel really badly for people who have to wait ages to have something like a Rx refill (like the 78 year old gentleman who sat quietly for almost 5 hours to get his furosemide refill). But this is not why I am an ER nurse. And yes, I know it comes with the territory. But I guess I need to get back to major tertiary centers before I forget how to run nitro, insulin, integrelin, and blood at the same time.

But now I feel at a bit of a loss. I don't think I know what I want to be when I grow up anymore!


On the upside I've met and worked with great people so far here, and have just agreed to come back for 5 weeks in July/Aug. Not so much for the ER side of things but because I love being on the ocean, having access to organic food and a decent gym (two things that most northern communities cannot boast).

Now on to more soul searching...

(People checking in at the triage tent this fall, somewhere near Chansal Pass...)


Bostonian in NY said...

Most sick people are's the stoic old guy with some heartburn and suprise 4mm STE in the inferior leads that scares the poo out of me.

The more you're in medicine, more the things that excite you will change: what is exciting to you now at the nursing level will be completely different from what excites you at the medical student, resident and attending level.

As a medical student, you'll be excited because you're completely in over your head, but you're learning and seeing the level 4's and 5's on your own is pretty sweet. As a resident, it's exciting because you kind of know what's going on and how to manage the sicker people, you stuck the intubation on the first try with the old-school laryngascope and your chest tubes went in without the attending even gowning. As an attending you're excited because you ran the critical case well, taught the residents and managed to keep the rest of the ED from grinding to a standstill.

Emergency Medicine isn't really about the undifferentiated life-or-death emergencies that might roll through the door or collapse on the triage desk. You're going to spend a lot of nights cursing yourself Sure they're adrenaline rushes, but it's about being able to treat everything that does constantly roll in, with the the resources available, as efficiently as possible. You'll see...

Oh yeah, and you'll probably end up changing the specialty you're interested in about 30 times in medical don't exhaust the soul searching yet and keep an open mind through out the whole process.

Keet said...

"Different strokes for different folks", "Whatever floats your boat/blows your hair back" and "yer mom and a bag of chips" come to mind...
"Ride it out cowgirl, ride it out"... Your path will unfold before you. :D
Cliche shmiche, but all true.
Can you tell I just woke up?

Albinoblackbear said...

BINY--Well I know one thing for sure...I don't want to have a family practice! Believe me, working in the Arctic, where the closest doctor is 4h away by plane has taught me plenty about managing cases in a timely manner, with the resources available.

I agree that the things that will excite me as an MD will change from how I feel now as a nurse. I know if I was staying a nurse it'd be time for me to mix it up and do something completely different...I feel the buds of cynicism/burnout growing and that is not me (at work).

My a.m attending today pretty much had me convinced to go into oncology and the p.m attending to do general surgery. So yeah, I am definitely going to just go with the flow and see where life takes me. I don't really have an agenda anymore and as daunting as that is...I'm okay with that. All of the amazing experiences in my life/career so far have been because I've been able to go "yeah, I'll try it" when something scary and unknown approaches. It'll probably just come down to me and a bottle of scotch sometime in third year. ;) Stay tuned! hahaha

Keet--Hows this for a complete offside?? I got an email from Mel today, talking about doing a Bushes reunion show...I think she was kidding...maybe I should just forget medicine and go back to being a rock star?? It just wouldn't be right without our #1 heckler though. Didn't you throw your tightie-whities at me on stage at the Sidetrack once???? Miss you and your mom jokes. EBSCO.