Friday, January 20, 2017

day in the life: emergency medicine

as always, some details have been changed

5:47 AM: I have to get up earlier than I normally do because we have an early morning meeting, so waking up was not super easy this morning! It's even harder when your bed is still warm ;)

5:55 AM: After brushing my teeth and washing my face, I put on my moisturizer, a quick sweep of my favorite concealer and powder, and then eyeliner, eyebrow pencil, and mascara. This is my bare minimum routine and I basically have it down to two minutes. I then spray some dry shampoo (the best!) in my hair, and throw it up into a bun.

6:15 AM: Time for the dogs to go out, and then it's breakfast time for all the animals! Lucy is particularly excited - she's been on a diet lately, so she doesn't have endless amount of kibbles anymore. After the animals get their breakfast, I make mine - a sausage omelet. 
6:25 AM: Because I'm not super hungry yet, I pack up my omelet, my lunch (zoodles and meatballs), and snacks (carrots + hummus, chicken breast + laughing cow, hippeas) into my lunch box. 

 6:30 AM: Then with my purse, lunch bag, and gym bag, I walk out the door looking like the bag lady I am.
6:35 AM: I'm pretty much no longer drinking caffeine regularly, but consider it a special treat, especially on earlier mornings. I stop to get a grande 1% cappuccino - so good!
 7:00 AM: Every few weeks we have Cancer Conference. This is a time where the surgeons, oncologists, radiologists, and pathologists come together to discuss some of the more unique cases they have encountered, what the pathology is, and how they are going about treating the patient. Todays' cases were mostly urology based (so bladder and prostate cancers), as well as a few from general surgery (colo-rectal cases).
8:00 AM: I make my way over to the ED. We have a small eight bed ED that should really have about 25 beds, so while we are small, we are very busy. I sit in the back room with the attending, and eat my omelet. As he has already seen the patients that are in beds, I wait for someone to be discharged so I can see the next patient. During that time, I read about my patients from the day before. This is what would make me a horrible EM doctor - I like to know what happens to my patients either after I or they leave! One of my patients from yesterday had been admitted for a pulmonary embolism, and another was shipped to the larger academic center due to complications of a previous surgery. 

8:15 AM: I read up on my first patient, an older gentleman whose chief complaint is shortness of breath. I have the advantage that I have access to both inpatient and outpatient records, which helps me a ton when I go to see the patient and also when I present to my attending. Patients don't always remember what medications they take or what medical problems they have, so having that access is extremely beneficial. After looking through the computer, I go to see the patient. We discuss his history, I do the physical exam, and then I head back to tell my attending about the history, physical findings, my differential (all the things I think he could possibly have based on symptoms), and the next steps (what tests or medications to order). Most of the time (depending on the severity of what the patient here for) the attending will order the tests and labs based on what I say, and then we will go see the patient together once the results start coming in. 

For the next two hours, this is the process over and over again for patients with a cut on their arm, blood in their stool, a missed period, a hangnail, and a broken jaw. 

10:30 AM: Snack time! I've really been loving smearing a Laughing Cow wedge on some rotisserie chicken deli slices and rolling it up - it tastes much better than it probably sounds ;)

And then more patients! Chief complaints include chest pain, UTI symptoms, pain from falling on the ice, and flu-like symptoms. 
12:45 PM: While we wait to get tests back for some of the patients, I have lunch. I made zucchini noodles earlier in the week and combined them with a tomato pesto sauce and turkey meatballs. It's one of my favorite meals!

In the afternoon, we see patients who present with a COPD exacerbation, pain from radiation, feeling unwell from chemo, blood in their urine, and a migraine. Because our ED is so small, each day can really vary. There are days where we have extremely sick patients - ones who are getting chest compressions in an attempt to keep them alive, ones who have to be medflighted out because they are having a STEMI (a heart attack) or have a tumor pressing on their spinal cord. Other times, we have more urgent-care type situations. Today was a good combination - patients who needed immediate medical attention, and others who could have been seen by their family doctor in an office. It's nice for me as a student because I get to see a variety of pathologies, but I do think I would be frustrated if I were an EM doctor when people misuse the ED for non-emergent situations.

5:00 PM: All done! I head out to the snowy parking lot, and make my drive over to my spin studio. While in the car, I eat the Hippeas I packed this morning. 
5:25 PM: I get to my spin studio, change into my leggings and tank top, and go find my favorite bike to stash my spin shoes, towel, and water bottle. 

5:30 PM: I have never been one to love exercising - in the past, I've done it but never really enjoyed it. Spin class has totally changed that for me. I feel like I'm obsessed! I really look forward to these classes - to just be in a dark room, spinning as fast or hard as I can, and not thinking about anything except being on the bike. This class is an hour long, mostly with hills with a few arm exercises built in. It's exhausting but amazing. As you can see, our studio is not some crazy fancy, but it gets the job done. 

7:30 PM: I get home, and CR has dinner ready. He had put some chicken breasts in the crockpot before he left for work, so we have shredded chicken and my favorite veggie tots (and bbq sauce and ranch, not pictured). If you guys haven't tried those veggie tots....please go drive to the nearest grocery story and get yourself some (they are in the freezer section). They are so good. 

After dinner, I shower, slap on my tretionoin cream + vanicream, try out my new eye cream, and then sit down to watch an episode of the Big Bang Theory with CR. 

9:15 PM: One of my resolutions was to fun read (while I still have the time), so I climb into bed and pick up Emperor of all Maladies. It's the "biography" of cancer - I've really enjoyed it so far, but I really love the history of medicine. CR puts the dogs to bed, and comes to bed to read too. Lucy, of course, comes to play, because that's what we do at 10 PM apparently ;)

10:15 PM: lights out!

Day in Review
hours slept: 7
hours exercised: 1
meals cooked: 1
hours studied: 0
patients seen on my own: 22