Emergency!

Hi there; Birdie here!

So the thing I forgot about having my emergency rotation the last couple of weeks is that it meant I was on emergency over Easter weekend. I mean, when I got the schedule I knew Friday was a holiday, but I was not prepared for Saturday...but that's getting ahead of myself.

Emergency works like most other rotations: when a student gets called for a case, we go up and get the history. Then we bring the animal back, do our physical, let the clinician do a quick physical, and figure out what we're doing next. Unlike oncology and other rotations, there is never any idea what the case will be the day before, obviously. Also unlike other rotations (except possibly medicine), we get critical patients that get taken back to ICU by one student while another student takes the history. And of course, on emergency we definitely don't get weekends off. But we do have two days off each week, which are possibly better than weekends off on other rotations because you actually don't need to come in, even to take care of a patient in the hospital or to take transfers. Also, most days don't start work until 4:30pm, so that meant I had days to do things. I definitely used one of those days to go to the library. Our rotation was big enough that one student was on days during the week. Then on weekends, roughly half of us were on days (8am-5:30pm) and the other half on nights (4:30pm to midnight). The end times were largely theoretical; even once we stopped taking cases, we still had to write up discharge summaries, which could take hours. There are no rounds in emergency, either. The caseload is majorly variable; some days we had basically nothing and some days the only reason I had time to eat was because someone brought food into the treatment room and I could snack while working on paperwork for my cases.

I never personally dealt with the really critical cases. We had two dogs hit by cars during my shifts, and for both of them I ended up getting the case that came in right before that, so I had to sit with that patient and try to do my physical alone while everyone else worked to stabilize the critical patient. I did have a possible GDV that I sent back to ICU (it turned out to be barely bloated) and a snakebite case that I sent back in case it needed immediate stabilization--both of which I was the history-taker for, and neither of which needed much in the way of stabilization anyway.

I really do love working with the clients. I'd always thought I would miss that if I decide to specialize, but now that I've actually done it it's not just a theoretical liking. We had one patient, a cat, hospitalized for the entire Easter weekend, where I made friends with the owner. I happened to be on days that entire weekend as well as the one who admitted the cat, so I stayed involved in that case. One day I stayed late so that the owner could visit. She told me that I really helped calm her and made a good impression of our hospital (she'd never been here before), so that makes me feel good about myself. At least I can actually do the client communication part of my job, and someone thinks I'm good at it.

Other parts, I'm not as good at. It was really only my second rotation at school, but I still felt overwhelmed by how much I didn't know, especially when it was really busy. One day I forgot to update my discharge at the end of the day, which was "inappropriate"--and got called as such. When we did a neuro exam,  the clinician explicitly did not ask which nerves each reflex tests--but I barely remembered what reflexes I was supposed to test, anyway. I also got snapped at for not knowing what to do when I cleaned Isolation (even after explicitly asking for help because I didn't know what I was doing--and when I later got told that it isn't even my job, anyway). And that's not even mentioning all the diagnoses I didn't get and drugs I didn't have dosages for. I'm recording this in the hopes of progress--I'm not competent yet, but I will be. I'm still learning.

Saturday was the craziest of all. There was one other day I was on cases for almost as much time, but only on the day before Easter did I personally have four different cases (okay, technically two of them were the same suspected toxicity, from the same owner) and my two classmates on with me have at least three each. And that's not even mentioning how many phone calls we kept fielding--everything from "my dog ate chocolate" to a scratch on an eye to the snakebite case that immediately came in. Luckily, some of the Medicine people stayed after taking transfers to help us with the huge influx of cases (it was a medicine student who did the physical on my snakebite dog). Other than anyone who stayed out of the goodness of their hearts, we only had two clinicians and three students. We were all running around like crazy dealing with something like a dozen cases all coming in at once, plus running more diagnostics on hospitalized patients. In the end, we got through it--but it was hugely stressful, with a lot happening all at once and me feeling like I had no clue how to help. And after the next shift started (that was a day shift, so the night students took over), we still had to write discharges. One of my classmates didn't leave his "day" shift until 9pm because he had to keep taking the phone calls no one else was available foor. That was definitely a defining moment for my decision that I do NOT want to do emergency work for my job.

I've kept up with my horseback riding, more or less. Off days on mergency gave me time to do that. Last week we did something really fun--a catch rider lesson. After warming up and riding a course of jumps once, we switched horses and rode it on each of the other four horses in the lesson. We stayed late (theoretically because no one had to go to school the next day, on Good Friday--I had to be at work at 8am, but I just rolled with it anyway) but it was totally worth it. I hope I get to play that game again. This week, the indoor arena had really hard footing since the tractor to drag it was broken, so we couldn't do much jumping. Instead, I got to learn a little about turns on the forehand and turns on the hind. Unfortunately, the horse I was on (Baby) is not very good at those turns. It was especially hard from a halt; she didn't want to move again! We did a fair approximation, though. I'd like to try again sometime. My instructor told me to remind her and I'll be able to try again on a horse who's better trained to it.

I'm so glad I'm done with emergency. I'm back in the classroom now for two weeks of electives--but that's a topic for another blog. After that I've got two rotations I've heard are tough (equine and surgery)--I'll try to record those as well, but at this point I have no idea what kind of time I'll have so I'm guessing none. Once I get through those, though, it'll be summer and I'll be away from school for three months on a combination of vacation and externships (slash "special topics," which is what school is calling the Live Oak Bank externship since it's not at a private practice). That's what I'm looking forward to most right now, and about as far into the future as I can think at this point.

Two rotations down...over a dozen to go.