Spent My Week at the ER--What a Neat Experience

This has been the week fomr hell. Bad things come in threes, right? If so then I am all caught up.
Tues evening I had gut wrenching abdominal pains in the upper right quadrant of my abdomen. Gall baldder came out in 2000 so it was not that. ER dr r/o liver and pancreas problems. He determined that I had strep in my large intestine. What the heck—has anyone ever heard of that?
He ordered me off for the week but being the idiot that I am, I kept on trucking. Thursday we had a husband and wife come into the mental health clinic with guns–they took a counselor hostage. The police surrounded our building while I was running a partial hospitalization group for paranoid schizophrenics. I thought we were all going to be gunned down but the officers did their work and we all ended up leaving w/o any bullet holes. I was pretty worked up, as I had a client hold me hostage for 3 hrs at gun point about 5 yrs ago and still struggle with a minor blip of PTSD now and then…but I have conquered most of it…thank god for good friends, my faith and a super support system!
Last night I was hosting friends fomr Canada. I started out down the steps from my back porch and they are quite steep–I was holding my daughter’s hand. She tripped and fell in front of me and I dove over her and somersaulted backwards down two stories of steps, dropping down about 15 feet, and landing on my knees on the concrete below. I blacked out for 5 minutes–per my husband who saw the whole thing–and was taken to the ER. I was xrayed and CT scanned from skull to lumbar area and they suspected a hairline fracture in my neck but after a number of CT’s they ruled it out. I came out of it with a sprained thumb, many bruises, a few cuts and a concussion. I thanked God as I thought on my way down --“This is it–I am going to snap my neck and die on these stairs”. It was one of the scariest moments of my life. I cried like a baby for hours as I replayed it in my mind and tried to remember details–which I still cannot.
The ER doc was great—patient, caring, thorough…I was impressed. I came home this morning and hurt like hell—but am grateful and feeling damn lucky to be alive and to be walking.
I am wondering–what kind of residency does it take to be an ER doc? What sort of personality type works best in an ER? I am curious—I suspect that I am too sensitive to do it–but I also can rise to the occasion and help people (like my paranoid schizos) calm down in crsis…
Anyone out there going into ER medicine?
aka “Grace”

Good Heavens, Erica, What a week you have had.
I sincerely hope this week is a much, much, much better one.
Keep safe and healthy!!!

Dear Erica,
I’m happy that you’re okay after a very eventful week. Is your daughter okay?
ER residency is generally a 3 year stint, although you could take a year “off” and do research or do a fellowship after residency in something like infectious diseases or community/public health.
The best ER docs I know (I’m premed and have volunteered in a few EDs) are calm, cool and collected–but also have the ability to work very quickly and decisively when the situation calls for it. They tend to be very practical people who don’t mince words on the job, although a wry sense of humor goes a long way during lulls or post-shift (an effective way to deal with the stress). Oh, and, speaking of stress, it can be very stressful at times, especially in a county ED. ER docs also tend to love a fast pace, short-term rewards/satisfaction and a breadth of presentations, rather than dealing with the tedium and minutiae of the medicine service for example.
It seems that the most opportune time to decide on a specialty is during 3rd year clerkships when one is exposed to an array of possibilities. That’s what I’m waiting for.

Erica -
You have found my love, my passion . . . . emergency medicine. I have volunteered and worked as an EMT for about 6 years, and am 95% sure that EM is what I want to specialize in.
Right now, there are plenty of EM jobs to be had. Residencies are somewhat competitive, but not as competitive as the top specialties. Most residencies are 3 years, but there are also two different types of 4 year residencies.
Emergency medicine will probably continue to grow in competitiveness. It is a fairly “young” specialty, and many original ER docs are on the verge of retiring. EM medicine is very attractive to many people due to a variety of reasons. ER physicians work set shifts - ranging from 8 - 12 hours. At an ED I worked out of, the docs were scheduled to work ten 12 hour shifts each month. The enjoyed quite a bit of flexibility, often trading shifts with other docs. As an ER physician, when your shift is over, you go home. Unlike many other specialties, you do not have to do on-call hours.
Pay is competitive. Most ER docs are either employed by a hosptial, or by a large EM physicians group that contracts with the hospitals to provide ED coverage. Another key advantage is that your malpractice is often paid as part of your benefits. There are usually opportunities to work additional hours, if you want, however one EM group’s website I looked at said their average MD worked ~30 hours per week.
There is also a wide range of ED’s. If you don’t think you are into as much trauma, rural ED’s do quite a bit of primary care. Rural ED’s currently face a slight shortage of MD’s willing to work in them, since there are so many jobs at city hospitals.
Personality wise - the best ER docs I know don’t let much of anything get to them. They roll with the punches and know how to adapt. You must be able to think on your feet. In a small ED, you are the only physician - it is your save, or your loss. EM does seem to suffer from a lot of burnout. I think this is because many people go into EM thinking they are going to save the world (from trauma, cardiac arrest, etc), and find out that they spend most of their shift on things that definitely AREN’T emergencies.
There are many EM resources on the web - several different EM organizations have websites. Check out the Society for Academic Emergency Medicine’s web page. www.saem.org They have many great links, including info on different residencies. If you go to the student medical section, they have a lot of great links that will detail the pros and cons of emergency medicine, job outlook, etc.
Hope this helps -
PS - If you can’t tell, I’ve spent a lot of time researching emergency medicine!

Wow, you had a heck of a week! I hope that you aren’t all sore from that nasty fall. I take it your daughter was okay then?? That’s also a pretty scary incident at your work! You just don’t think about people coming in with guns to your work…or maybe you do in a clinical psych setting Anyway, looks like you got some good advice on EM. I’ve never met Dr. Luka (from “ER”) DARN!!!

My little girl is fine–she was upset but we have discussed it over and over again (her initiation and choice) and it seems to be put to rest now.
I ended up with a grade 3 concussion, contusions, sprains and some anxiety about the blasted stairway. I HATE stairs anyway–I beg hubby to carry laundry up and down from the basement for me.
I am thanking God and all the angels in heaven that I did not break my neck–someone was watching out for me!
Erica (aka Grace)