Rotation roundup: Emergency medicine

This one’s a bit belated – the CaRMS process has prevented me from getting ahead of my blogging stuff.  A sardonic post regarding it is likely in the blog’s future.

(Not to mention I’ve been somewhat preoccupied with this BBC show a couple of people watch.)

But I digress.  How are you?  Enjoying this atrocious winter weather?  It’s been so long, I can hardly remember what you look like.  Or your name, if you happen to be one of my classmates.  If I give you that searching, blank look when I see you in hospital, try not to judge me too harshly.  I daresay you know what CaRMS does to the brain.

Ages ago, I did a rather brief, 2-week elective in Williams Lake, BC in ER medicine.  For those who aren’t familiar with this little place, Williams Lake has a rather interestingly blended patient population of vacationers, tradespeople, and Native people from the surrounding areas.  It’s built on forestry and a local mill, though its abundance in natural beauty and nearness to places like 100 Mile House, Horsefly, and Wells Gray Provincial park make it a popular spot for summer homes.

But how was the medicine itself, you ask?  Cozy up and I’ll tell ya.

The where: Cariboo Memorial Hospital, Williams Lake

The good:  Like family medicine, ER is a diverse specialty.  Especially in a smaller town, the ER doc also acts as the on-call for many services so they must have a good grasp of a broad range of topics.  (For example, the doc I was working with was called away to an emergency C-section to act as the neonatologist.)  The unpredictability makes things challenging, but always fun.  Who knows if that next patient with pleuritic chest pain has garden variety pneumonia or actually has a pulmonary embolism?  The likelihood of life-threatening presentations is far higher and the stakes are certainly raised.  And as always, making that diagnosis is immensely satisfying, especially when you identify something serious and treatable (like a PE).  I remember actually watching as a patient went from 1st degree to complete heart block over the course of a few hours.  Ooh, and so many procedures.  I did everything from casting to suturing to pulling an industrial nail from a finger.

The not-so-good:  Things are BUSY.  Very busy.  You’re constantly under pressure to clear your list and get all the patients seen but still get everyone the care they need.  There’s an instinct you develop within your “sick/not sick” dichotomy; sick people need help now, but not sick people can rapidly become sick people without the right investigations and treatment.  The differentiation is difficult and getting it wrong feels horrible.  With such raised stakes, people do die under your care sometimes.  Usually there’s very little you can do, but it’s certainly no consolation to the family.  Plus, the very sick people can’t be managed in a smaller center, so transporting them becomes a harrowing process that would never have been necessary in a place like Vancouver.  One smallish quibble: that ER was often the entry point for patients to be admitted to a specialized psychiatry ward, and sometimes staff of all varieties were less than understanding.

The verdict:  Good fun, though stressful.  For some reason, I do feel the pressure to know the ER techniques in resuscitation and acute care in order to round out my knowledge, but I also know that there are pros and cons in going for a 2+1 degree in family and emergency.  It’s something I’m still mulling over, and hopefully with more experience and a few electives, I’ll be better able to make up my mind.

Well, only have a rotation or two to catch up on for roundups.  Soon, my pretties, soon.

 – Atalanta


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