The Real Tales of an Intern Part 3
Emergency rooms will be used the way they were intended to be used: not for primary care, but for when the average freaky American get some strange object up his ass. -Bill Maher
“Has anyone seen Sam? This place is a madhouse, we need all hands on deck.” “Have you checked the doctor’s room or the ambulance bay?” Fabian walked away to the nurses’ bay. “Sister, we have a new intern, Dr. Samantha, we call her Sam. She is of average height…” “Check the doctor’s room, I saw a lady there looking lost.” Fabian smiled and walked into the doctor’s room. “Sam, what’s up with you?” She looked up at Fabian without saying a word. “This place is chaotic, we need you outside.” “I don’t know what I am doing. I am confused.” Fabian sat on the call bed. “It gets that way on the first day here. Do what you can, take the histories. Ask for help, please. Don’t shy away. We are a team.”
Sam felt better. Earlier, she had seen this middle-aged man brought in a gurney. He looked lethargic and dehydrated. He wasn’t speaking much. The relatives had mentioned that he had been this way for days. She asked them if he had an existing medical condition and was taking medications. They had given Sam a bag of drugs. There were too many drugs. Sam wasn’t sure the last time she had seen that many drugs for one person. The worst part of it was she could not put her finger on what the issue was. She thought about working from first principles; take a history, analyze the information. While she was staring at the patient in confusion, the head of the team had walked over to Sam. “Sam, how are you? Are you good?” “Yes sir.” And he walked away. Of course, she was not good. She was in disarray. But she did not realize she ought to have spoken up.
It was this disarray that brought her to the doctor’s room to get herself together. Then Fabian found her and made it clear this was teamwork. “Do you have some time? I want to discuss a case with you.” “Hit me.” “Earlier, I saw a middle-aged man, lethargic, partly unresponsive, and dehydrated. I can’t put my finger on what was wrong with him.” “What were his vitals?” “Blood pressure was normal but he was febrile and his pulse was raising.” “Any past medical history?” “His family was ambiguous with that.” “Any pointers with his medications?” “They were too many.” “Do you have them on you?” “Yes.” Sam gave Fabian the drugs. He noticed that there were antidiabetic drugs in the pile. “Ask the nurses to run a blood sugar test. This patient might be having a diabetic crisis precipitated by infection.”
Sam ran out to the nurse’s bay to speak with one of the nurses. With the blood sugar of her patient checked, it was through the roof. Sam recalled her professor talking about starting a saline infusion with insulin. This was a step in bringing the blood sugar down. She also took blood samples to do a complete blood count. It was important to see his white cell count. She looked around for Fabian to give an update but could not find him. “Dr. Sam, please come to bed 10, the patient is having a seizure.” “This is a war zone”, Sam said to herself as she grabbed the patient’s chart
By evening, the emergency room was quiet. Sam asked one of the nurses on duty: “Will it stay this way?” The lady looked at Sam and smiled: “This is your first day here, right? It never stays this way. That’s why it is an emergency. The moment you think you want to chill, you hear the ambulance sirens.” At that moment, the paramedics brought in a man with a knife injury to his thigh. “Call the surgeon on call. Sam, please put a line. He would need a transfusion.” Sam echoed: “of course it never stays this way. It’s a bloody emergency.” She wheeled an IV set up kit to the man’s side.
The hospital Sam chose for her internship was in a part of the city notorious for gangsters. This type of patient was ‘normal’ in the emergency any day of the week. If it wasn’t the drama of the emergency, it was the overwhelming number of people at the outpatient. Chad might have known all this while, asking her not to come here. This place felt like a battlefield, enough for a lifetime.