There's a Reason I Wanted to Do Surgery

O.K. When I was deciding on my specialty in medical school, there were several criteria that I wanted to meet.  One had to do with working in or out of the hospital (I wanted in).  The next had to do with how much clinic I would have to do (little to none).  And, the final criteria had to do with gyn exams.  Hate them, hate doing them, some things in life I don't really want to see on anyone.

So when the time came to decide, surgery was a great fit.  I would be working in a hospital, I would have very little clinic, and, for the most part, very rarely would I ever have to do a gym exam.  And, so it's been for the last 4 years.  I did my last gyn exam as a 4th year medical student in May of 2003.  Until yesterday.....


My home for the next month.

On my very first shift, with my very first patient.  I saw the tag on the board, "Abdominal Pain."  No problem.  I was a surgery resident, and we are well versed in Abdominal pain.  As an Emergency Medicine resident, I walked in the room and met my patient who described a severe pain in her upper abdomen.  No problem.  "Oh yeah, Doc, by the way, the pain actually started in my lower abdomen, well pelvis actually, and now that I think about it, I had unprotected sex about the same time the pain started and could I be pregnant or have an STD?"  Major problem.

Suddenly, I felt like a medical student again.  I went to my chief resident to present the patient, and I had to admit it had been 4 years since I had done a gyn exam.  He was like, "No problem.  Grab the cart, grab some swabs, do a wet mount and I'll show you where the microscope is."   Um, "wet mount?"  I think I heard something about that during my OB/Gyn rotation in medical school, 3rd year...  So, I was walked through the procedure by my chief;  who, by the way, also had to help me with the microscope because I hadn't used one of those since 2nd year histology class.  Needless to say, it was not a very pleasant beginning.

Luckily, it was the only gyn exam of the day.  During the course of the next 9 hours I saw a total of 6 patients.  It doesn't sound like much considering some family practice doctors see 4 - 6 patients an hour.  But, you have to realize that in the Emergency Department a doctor may manage 4 - 5 patients an hour, and they all don't leave within fifteen minutes. 

For example, my first patient had to have a pregnancy test and an ultrasound (the culture swabs I obtained won't be ready for 2 days.)  So, she took about 2 hours from start to finish.  After my exam, I saw my next patient while I waited for patient #1's lab results and ultrasound results to come through.  Pt #2 was very sick and needed constant re-evaluation.  He ended up needing a chest x-ray, CT scan, multiple labs, a cardiac echo and would need admission to the ICU.  I saw him at the beginning of my second hour, it took 4 hours to get all of the labs and imaging studies done, and when I left 7 hours later, he was just being seen by the admitting service in the ICU.  While I was waiting on his work-up studies, I saw 4 more patients:  a musculoskeletal chest pain, a drug allergy reaction, a patient with fluid in one lung most likely from lung cancer, and a 20 something who woke up blind in one eye.  A nice mixed bag of patients.  Like I used to say in med school, "The ED is like a box of chocolates, you never know what you're going to get and some are just plain nuts."

So, this was my first day.  I know I will get better.  I know eventually I'll stop feeling like a medical student and start feeling like a doctor again.  I know soon I will be able to manage more than a patient or two an hour.  And, those gyn exams... I'll just have to take them one day at a time.

Tags: emergency department, ECMC, gyn exams, first day