Wednesday, November 21, 2007

Triumphs in the Emergency Room

Working in the emergency room is great. I feel like the patients I see are really mine, since I do all of the initial workup, and that is very satisfying. The consultants have been excellent preceptors, and the residents very helpful and willing to teach as well.

Last night I had two particular triumphs. One of my patients was a teenager who had a one-sided sore throat and swelling. On examination, she had one enormous tonsil, which was actually pushing her uvula over. Now, if you've been to medical school, you are jumping up and down right now and yelling "peritonsillar abscess! peritonsillar abscess!" This is a classic finding, and I had read about it but never seen it, and it was SO satisfying to recognize what the problem was and to be able to tell the consultant so with some confidence. As I've written about before, third year is full of feeling dumb, and it was nice to actually diagnose something. (Other than viral upper respiratory infections. We do a lot of that in the emergency room.)

The other nice moment involved an infant with...drumroll please...a viral upper respiratory tract infection. That part was pretty obvious, but when I looked in her ears, I thought that one of her eardrums was a little redder than the other. Now, she was really squirmy, and 4 month olds have tiny little ear canals, and there was some wax in the way, so I was in no way SURE that this was what I saw. It's really tempting when I have an equivocal finding like this to not mention it, and just let the consultant draw her own conclusions from her own exam. However, I have also realized that the only way to get better at detecting physical exam findings is to mention them and then see if I'm right, so I did tell her. And it turned out that that ear DID look a bit redder than the other one.

So, good times in the emergency room. I have one more shift tonight, and then a four-day weekend. There will be plenty of studying during the weekend, but it will be a nice chance to gear up before starting the inpatient service on Monday. We have a very quiet weekend planned. I'm just looking forward to spending time with Alex—since I've been in the ED from 4PM -midnight, and he's at work from 7:30 to 5:30, we've only been catching each other for a few minutes a day when I come home and he's falling asleep. Jasper and I have been spending some quality time together in the mornings, but we've actually had really poor air quality here so no running the last couple of days. We did drive up to Minneapolis yesterday to hunt and gather a Tofurkey for Thanksgiving. Very odd that our co-op here in town didn't have them, but it gave me a chance to pick up more of Jasper's vegetarian kibble, too.

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