“A new crop of residents, eh? Which are you: the egoist, the stammerer, or Mr. Empathy?” Ms. Brunner is a wry, wiry woman in her mid-60’s with severe Crohn’s disease, an illness characterized primarily by inflammation of the digestive tract (“gums to bum”). I made her acquaintance on my 29th day of residency, and first on General Surgery. Prior to meeting an admitted patient, it important to familiarize one’s self with their medical history and expected course of treatment. Being a keen, green resident, I was dismayed to find Ms. B’s thick chart prefixed with the label “Volume 3” on the bulging cover. Turns out, she had been hospitalized for 10 consecutive months by the time I took over her care. In that time ten different teams of residents had rotated through her ward – each with an optimistic outlook and promise of a rapid discharge home. Three major surgeries later, Ms. Brunner understandably portrayed the rather sardonic attitude of a chronic patient. Yet the bored tone and pursed lips were betrayed by her playful, intelligent green eyes. “Well, Ms. Brunner, I understand you must be feeling frus-” “Mr. Empathy, eh? Damn, there were 3 of you last block, and the Egoists are more fun to mess with. You must be an off service resident; want to see my guts?” “Umm…”

Residency is an unpredictable, angry sea, dear reader. No matter which specialty you happen to be training in (i.e. Internal Medicine, Anesthesiology, Pathology, or Emergency to name but a few), it is usually expected that new physicians gain experience in a variety of fields related to – but outside of – their own. That young gynecology resident checking your cervix in clinic might in fact be an aspiring radiologist. The squeamish fresh face stitching up your knee in the ER is really a psychiatry resident who has that forgotten vessels hold blood and not the four humors. (I kid of course, junior residents are directly supervised by attending physicians and only perform procedures they are expected to have comfort in.) For five years, our lives are divided into four week rotations (“blocks”). One month you may be floating comfortably through the psychiatry ward, enjoying the gentle waves of conversation and high-pitched echolocation of the patients. Then the skies darken, and your life raft of psychotropic meds won’t protect you from the long hours and torrential currents of general surgery, which will undoubtedly leave you wet and shivering when it is through with you 28 days later. Rinse. Repeat.

Emergency medicine residents perform more “off-service” blocks than most other specialists. As you might imagine, emergency physicians are experts in systemic acuity. In those first minutes-to-hours of a trauma, heart attack, stroke, or ruptured appendix it is the emerge doc’s job to make the diagnosis, stabilize the patient, initiate treatment, and get the appropriate specialists involved. This requires an in-depth understanding of the medicine and logistics of our consultants. No, we are not trained in removing a gallbladder. But we do need to be proficient at recognizing when the organ is infected/causing illness, and then put the wheels in motion for definitive management (often an eventual cholecystectomy, or gallbladder removal operation). For that reason, we spend approximately half of each year in training working outside the emergency department as members of other specialty teams. On any given month, emergency residents can be found working in a variety of areas including (but not limited to) intensive care, cardiology, various surgical specialties, even with paramedics!

So why do you care? Maybe you don’t. Because, really, aren’t those doctors working in emerge just “glorified triage nurses”? (This term irks me to no end, not because it is an insult to emergency physicians, but because it implies triage nurses have an easy thoughtless job. They are the front line of any ER and entire hospitals would be in shambles without them.)

Just give me my antibiotics, my painkillers; my school-note, my stitches; and let me go home!

But maybe you do care. Maybe you have a basic, passive curiosity about our training. Maybe you are an aspiring future physician wondering what life will be like when you finally don that white coat and stethoscope. Or maybe you recognize that by virtue of living in a first-world country with timely access to health care you will likely one day make a personal visit to an emergency room – whether for yourself, a friend, or a loved one. I strongly believe it is vitally important for users of any system to understand how that system functions.

No matter your reason for visiting, hospitals can be scary, confusing entities. There are numerous social constructs on what emergency physicians are. Popular television shows either over-emphasize our drama and confidence (ER and Untold Stories of the ER) or pretend we don’t exist as a specialty (Scrubs, Grey’s Anatomy and House). While the common comparison I keep getting to a young George Clooney is appreciated, I imagine it’s based more on looks and bedside manner than a true medical prowess.

By aiding your understanding of how emergency residence train, what we experience, and what our limitations are, I hope to demystify your hospital experience.

As I write this entry, I am preparing to return to the emergency department for two consecutive blocks on Emergency Medicine (first adult EM, then pediatric EM). After 3 straight months off service, I am giddy with excitement at the prospect of reuniting with the incredible team of nurses, clerks, porters, volunteers, residents, and attending physicians. But, dear reader, I hope not to see you during my shifts. Should you fall ill, however, you know where to find us. We are open and here for you 24/7/365.

Ms. Brunner raised her hospital gown to reveal her open abdominal cavity. “Yup, those are your guts alright.” Instead of a nice clean row of stitches across her surgical incision, the surgeon had decided to use a VAC dressing to cover the wound. (“Vacuum Assisted Closure” This is essentially a fancy piece of plastic vacuumed over an open surgical site, used to enhance wound closure. Yes, it is completely transparent.) Hiding my gritted teeth behind a closed-mouthed grin and a deep swallow, I was sure I did an excellent job at concealing my moment of surprise. I can be Mr. Ego if I want! Ms. B laughed at me (bringing on a second deep swallow – it’s not every day you see an open abdomen reverberate with laughter…) and gave me a knowing wink as I finished my exam and turned to leave. “Enjoy your general surgery rotation! I know I will!”

– Vitamin K

I am a junior emergency medicine resident in Vancouver, British Columbia. This blog is a collection of stories from my experiences in training. I do not represent my program or any other residents; the ideas and opinions are my own. This should NOT be used for medical advice. Names, events, and identifying information of patients and staff have been altered to ensure confidentiality of those involved.



If you enjoyed this post, please leave a comment/reply 🙂

