A Medical Student’s Perspective
There is
an ancient curse, it goes "May you live in interesting times"…
Terry Pratchett, Interesting Time
From when we were baby medical students, we were taught to recite the disclaimer : "I would like to resuscitate the patient, first checking the airway..." We would usually be cut off mid-sentence by bored examiners who had heard the exact same script ad nauseum, perfected to the exact monotonous intonation by all the previous clones.
As such, we would usually skip the emergency
management and go on to the “Now imagine that you are a houseman in the
ward, what is your management?” bit. But as I recently discovered,
resuscitation in the A&E is not quite the ABCs they make it out to be.
As part of our 3rd year curriculum, we had already done a 3-week stint at
the emergency department. However, being constrained by the laws of physics,
it was simply impossible for 10 medical students to get within a 1-metre
radius of the patient without subjecting ourselves to acrobatic contortions
like those seen at the Cirque du Soleil.
Hence, an elective posting in 4th year
helped me get a much more up-close-and ( occasionally too )-personal ( like
when an inebriated patient emptied his gastric contents onto my shoes )
experience in the Emergency Department. However, our transition from
textbook to practical management must have caused many tutors to exhibit
exophthalmos and malignant hypertension. I knew how to calculate the FiO2
delivered by nasal prongs, what their indications and limitations were, but
my trusty friend Harrison’s had not
told me that there was an upward direction in which the nasal prongs should
face!
As the month went by, circadian rhythms were replaced by the interminable
fluorescent daylight of the A&E. Even late at night, the cubicles were
rarely empty, and there was always something to see or do. Who needs Rubik
cubes, when figuring out how to manoeuvre a patient’s trolley through 20
other beds packed like canned sardines provides much more intellectual
stimulation?
Despite the seemingly endless queue of patients - ready victims for clerking
– on busy shifts, we spent half our time doing things that were not part of
our log book requirements. How many medical students does it take to help a
patient onto a bedpan? That day, it took 3, and not before 10 minutes of
deep discussion about Newton's laws
and the ergonomics of bedpans in general.
Each shift brought its own set of hilarious and frustrating moments – there
never seemed to be a mundane day. It certainly takes all sorts to make up
the emergency department crowd. Sometimes, we were stressed to the limits by
irate patients who remained dissatisfied even though we had gone back and
forth 3 times to get them a glass of water the exact temperature that they
wanted.
On other days, we laughed with a patient whose bed had mysteriously gone
missing after she’d left for the washroom, and were sheepishly apologetic to
elderly aunties who insisted that it was all right to make mistakes, just
after we’d botched their IV cannulation.
As a tutor once told us “You save the patient, and when he wakes up he
thanks the doctor in the ward whom he thinks has saved his life.” But I
think the A&E has its redeeming moments. At the end of the posting, we all
had a clearer picture of what life will be like as an emergency physician.
Our views may have changed in one way or another, but we definitely agree
unanimously on one point – even though we may never return to work in the
ER, we applaud those who do.
Cheng Su Lin