My third rotation was emergency medicine and it afforded me a different perspective on patient care and the general approach to a patient. Where my weeks in pediatric and ob/gyn clinics taught me long-term management and wellness being in the ED required me to look at the most pressing and potentially life-threatening issues first. I was asked multiple times by various residents and attendings, “what will kill them now if we don’t intervene”. It was with that moto in mind that I questioned and examined patients and formed my differential.

The emergency room in which I rotated through was a level-one trauma center in a particularly rough neighborhood where many people had very little access to routine health care. This meant that we saw many patients in need of immediate life-saving medical attention and many patients who should probably be seeing their primary care physician for the problem they presented to the emergency room with. In the course of one day I saw two patients in cardiac arrest, one stabbing victim, and one young woman who waited for 6 hours just to get a sonogram of her baby and then eloped without any of her discharge instructions or follow up as soon as the sonogram was over.

In a busy hospital like Brookdale I really came to understand the meaning of teamwork. When there are days with 50+ patients being seen by your team, each member of that team matters and if one part of that team falters everyone is set back. During each shift in the ED I did my very best to help out wherever I could. Sometimes that meant seeing patients and presenting to the resident or attending I was working with for the day. Sometimes that meant drawing labs or starting IVs for nurses and sometimes that meant transporting the patients to and from x-ray or CT scan or taking vitals for the PCTs. I did my best to support every member of the team so that patients could be seen and cared for in a timely manner and in doing so was able to get a lot out of my rotation. I now feel more comfortable eliciting a history and doing a thorough physical examination in a timely fashion. I have also gotten a number of clinical skills under my belt like drawing blood, starting an IV line, drawing an ABG, suturing, giving an injection, and performing CPR. Doing what some may consider to be menial work enable me to become more familiar with hospital equipment, IV catheters, different syringes and needles, IV bags and tubing, patient monitor set up and how to operate those complicated hospital beds. Understanding your equipment, where to find it, and how to use it is a very underrated part of what clinicians do and as a student it can be very intimidating when you know clinically what to do but not how to practically apply it in your current setting.

During this rotation I got a lot of practice with note writing and am feeling more and more confident with my HPI, however I am still struggling with adjusting my assessment to the preferences of my various preceptors throughout my sifts. While some like the assessment to include PMH others do not, some want a concise assessment while others want your differential included. I have to say, working with a different person each shift made me better at adapting my notes, but I know they still need work. My goal for this next rotation is to get my HPI and assessment down and to start working on formulating plans for the patients I see and then comparing what I have come up with to those in the notes. Overall my emergency medicine rotation taught me so many things. I was able to work with young, talented physicians who were very current in their clinical practice and I now look forward to taking the skills I have acquired and applying them in my surgery rotation. Brookdale, it was real.

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