Lessons from the ER, Part I: Leave Your Jimmy Choos at home

I sat at my computer station, staring at the ER patient status board on the screen.

Twelve patients in the entire ED. Twelve. Out of thirty-four beds, fewer than half of them had bodies. And about a third of those weren’t even real emergency cases, just whiny twenty-somethings with itchy va-jay-jays and blood in their urine.

I poked my head out into the waiting room. Not a heartbeat.

The clock on the pastel-white wall by the ambulance bay mocked me. 3:06am. Four more hours left on the shift, and only one new patient every bajillion minutes. Hey, who knows, I might even be let off early.

You might wonder why I’m complaining when I’m getting paid to sit on my butt and do nothing. But that’s not why I took this job. If I wanted to get paid for doing nothing, I’d be the Offensive Coordinator for the Indianapolis Colts (with a healthy Peyton Manning, of course - let’s face it, when Peyton’s on the field, he IS the OC).

I wanted this job because I wanted to see everything I haven’t had the opportunity to see. (Or maybe haven’t been allowed to see. Helicopter parents, virgin eyes, first world problems – you know.)

I am an Emergency Department Scribe. Each shift, I am assigned to work with an ER physician, and we see every patient together. I document every part of the visit, including the patient’s complaints, history, physical examination, lab/film results, and disposition. One might argue it’s just fast-paced, glorified personal-assistant-type bitchwork. I think it’s the coolest job in the world for a pre-med, especially since I’ve handled most of first-year medical school courses. There’s no other job that lets someone with my qualifications see a patient high on PCP challenge nurses to fistfights, an idiot with a gunshot wound to the chest who barricaded himself in his house and stupidly dared the cops to “try an’ git me,” and a chronic drug-seeker drama queen cryyyy all within one eight-hour shift. Psssst pre-meds reading this: TAKE THE HINT AND GET THIS JOB.

I spent all of last year with my head in the books, learning about the cellular mechanisms and clinical ramifications of blah blah blah. And I’ve certainly paid my dues volunteering in the ER, making beds and stocking blankets. But this job is my first time actually getting my eyes dirty. There are many things books can teach you, but there’s nothing quite like being put to the test with experience and apprenticeship.

Diabetic foot ulceration is a perfect example. “Diabetic foot” develops when someone with uncontrolled diabetes mellitus developing peripheral neuropathy, meaning their peripheral sensory nerves no longer work. The foot no longer transmits sensation of pain, so any injury on the foot is likely unnoticed and left untreated. Furthermore, diabetes leads to complications in the blood vessels, making it far more difficult for a wound to heal. Lack of notice/care plus a slow-healing wound leads to ulceration of the foot. Unfortunately, many of these cases end up as amputees.

We’ve all seen pictures of diabetic foot (warning: severely NSFW). And yeah, they’re pretty gross, especially when they’re blown up 500x on the big projector screen in the lecture hall. But until you’ve walked into that patient room and smelled the ulcer, you can’t really comprehend the full experience of seeing a diabetic foot…unless you HAVE diabetic foot, I suppose, in which case please stop reading this and go see a doctor like NOW.

My point is that experience matters. Your GPA and MCAT scores only say so much about you. Surviving after being thrown in the fire is a whole different beast. Versatility, adaptability, and willingness to learn from your mistakes are imperative for success in this field.

First important lesson I’ve learned as an ED Scribe: wear comfortable shoes. Constantly rushing from room to room takes its toll over the course of a 9-10 hour shift. Comfortable shoes that don’t wreak havoc on your joints are as crucial as staying awake while cutting into a patient. On my first shift back in August, I thought I’d go for the more professional look and wore my business casual leather browns. By the fourth hour, I was ready to beg my physician for painkillers or, failing that, to just cut off both my feet so I could stop hurting.

The hospital might be the one safe-haven on Earth where people won’t judge you for wearing those god-awful Skechers Shape-Ups or Crocs. Judging by the number of nurses – and doctors! – who wear Shape-Ups, I guess they must be pretty darn comfortable for them to sacrifice that many style points. (You will still never catch me dead in those. Just look at what it did to Joe Montana’s reputation.)

Another night shift beckons, friends. Stay warm, Go Bears, and whatever you do, do NOT Google "night shift nurses."