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Day 1 in the ED

Today I started as a fresh intern in the ED. I chose to start with ED as my first term and this morning during my drive to work I certainly questioned that a few times – I’ve been told that ED is one of the few places in internship where you have a bit of autonomy/can take leadership with your cases a bit more.. of course this means you have to sort of know where your cases are going.

After 6 years of medical school and a week of boring administration & introduction lectures I felt entirely unprepared to start managing my own patients. This is something that gets brought up a lot by interns, registrars and consultants when they move up the food-chain, that feeling of being an imposter and like you don’t know anything. I was always a perhaps slightly over-confident medical student and yet this morning I felt like I was literally about to walk into a 10 hour long OSCE station that I couldn’t possibly have prepared enough for.

I spent my day seeing predominantly chest pains, which is really no surprise to anyone who has been in an ED. My first prescription was for some “more fentanyl” in a middle aged man with 8/10 chest pain who had already had 250microg of Fentanyl and looked like that 250microg had never actually made it into the cannula. Unfortunately that fentanyl had made it through and the extra fentanyl + GTN I charted really didn’t do anything either, and so within <10 minutes of starting my shift I found myself standing in front of my consultant saying “I have no idea what to do about this man’s pain”. Thankfully consultants are pretty good at knowing what to do most of the time and my consultants seem to be particularly happy to help out a struggling intern.

Most of the chest pains I saw today weren’t serious, most were costochondritis/muscular or reflux related. One was very serious and the speed they made it through the system impressed me a lot. Another patient made me quite sad – carer stress/fatigue and the resulting complications (sepsis + rhabdomyolysis) is not something I’ve figured out how to cope with yet; most of the time I just feel bad for everyone involved.

Before today I certainly felt like it wasn’t my place to talk about acute resuscitation plans with family but that’s where I ended up – somewhere between graduating medical school and now that became an appropriate thing for me to be directly involved in. Overall that’s how most of the day felt, like somewhere between graduating and now I was suddenly allowed and expected to do a lot of things that I knew about, had seen, had been involved in but had never actually had direct responsibility for.

It feels a lot different from medical school but I like the team, I like the medicine and I like the work.

Ben is currently working as a PGY4 junior registrar in Intensive Care.