Redundancy

So I have only a few more days left on the cardiology rotation. Thankfully I'll be back on the ED soon. I have enjoyed being a part of the cardiology team and having the opportunity to provide a more definitive care. In the ED, heart attacks, although obviously very serious, are pretty routine. A STEMI goes straight to the cath lab, an NSTEMI is stabilized medically and then admitted to the cardiology service, and of course CHF exacerbations are initially cared for in the ED and then transferred to the floor should it be necessary. I've enjoyed being a part of the receiving team this month and seeing the patient through until the end.

While interesting, cardiology did seem a bit redundant towards the end. If you have a blocked artery or two, you get a stent(s). If you have multi-vessel disease, you go to surgery. If you're having a CHF exacerbation, you get diuresed until your kidneys can't take it anymore. That is obviously and over-simplified viewpoint of it, but it did make me realize I still made the right decision to go in to emergency medicine.

I chose to become an ED physician because there was nothing in medicine that I enjoyed so much that I would want to do it everyday for my career. I always thought being a sub-specialist in medicine or surgery, focusing on basically one organ system of the body would become boring after a while. I've only bend doing cardiology for 25 days now, but I'm already tired of treating heart attacks.

So, while I lack the opportunity to provide definitive care more times than not, there is nothing redundant about a day in the ED. When I get back to the ER next Friday, I may see one person having an MI, seven people having an MI, or not see one for three weeks, and that is fine with me.

Code Blue

So at this point in the year a code blue doesn't get the adrenaline rushing like it used to. Don't get me wrong, it still pumps pretty strong, but its a different feeling with the adrenaline rushing and not knowing what to do versus having the adrenaline rush and the competence to know how to proceed.

I'm still on my cardiology off-service month, and the other day during rounds the code blue alert sounded. The entire team knew immediately it was one of our patients as we had been expecting it at any time. Me, the other intern, and the senior resident all rushed to the room. Along with a handful of nurses, two respiratory therapist and a pharmacist, I was the only ED doc in the room. I walked to the head of the bed and started bagging as the patient was found to be in P.E.A. I requested fentanyl and versed and immediately began preparing to intubate. All we had for access was two peripheral IVs and I heard the senior resident (who was running the code) request a triple lumen kit. I looked at him and politely suggested we put in a triple lumen. He agreed. While waiting on the medications I requested I observed the other medicine intern preparing for the central line placement. I've seen people put together jig-saw puzzles quicker. After I secured the airway, I went over and took over the line placement. First attempt, got it.

Don't get me wrong, my medicine colleagues are very competent when it comes to practicing medicine. I'm definitely not trying to suggest otherwise, but when it comes to procedures, especially in the emergent setting, that is when we ED docs shine. The patient survived the code, and we all felt pretty good about ourselves.

Whenever I'm on an off-service rotation, the other docs are never at a loss of words when it comes to expressing their opinion about the ED. But what it boils down to is, in the acute setting, no one is better in saving lives, and the above situation is just further proof. I didn't run the code, I just did all the work.

Off service

So I'm on an off-service rotation right now: Cardiology. I already have some good stories to tell, but now I have to deal with q4 call and the sorts so my postings will slow for the next few weeks. They'll pick back up soon. Hang in there.