EM Month Winding Down and First Interview

I was very proud of myself recently. I saw a patient with a history of panic attacks and meth addiction. Supposedly the meth from her most recent relapse had worn off and she was solely under the influence of a panic attack when she got to the ER, but I have my doubts. In any case, what I'm proud of is that I was able to calm her down with with a reassuring tone, redirecting her attention, and having her do deep breathing. This was an ego boost not only because I was able to calm a distraught patient, but more so because the whole time I was thinking what a mess her life is and how I didn't want to be dealing with her. So, yes, I'm bragging about my hypocrisy in some ways. It's important, though, to be able to get over your own feelings, judgments, etc. about a patient and be able to provide appropriate treatment. I thought I was already cynical, but this month in the ER with at least a third of my patients being drug seekers has really been an eye-opener and tried my standpoints on the cutoff between providing for patients' needs and being an enabler of unhealthy habits.

Another interesting patient was a quite mature, almost precocious, teen with abdominal pain. I needed to examine the patient's abdomen, and decided it would be best to do so without pants in the way (US pants, not UK pants). I was reminded of the Scrubs episode in which Turk is reluctant to see his doctor because he has to take his pants off for all visits. "Oh, you have a sore throat? Ok, take off your pants and I'll be back in a moment." This ER patient is also a Scrubs fan and I was able to connect over the pop-culture reference. With this patient's maturity level, I had already been able to establish a good rapport, but it was good to see how that personal connection can further put a patient at ease. After the initial ER workup, the general surgeon admitted the patient for observation since the pain was reminiscent of appendicitis, but wasn't as severe as would be expected, plus the appendix was not assessable on CT.

It's worth while to highlight some differences between the two patients above. For the drug addict, I had to step up my interaction with her from my default of not wanting to deal with her. For the teen, I was drawn into conversation and had to rein in my desire to chat in too informal a manner. In both cases, it was important to form a personal connection with the person while maintaining objective professionalism.

I was invited for my first interview yesterday. I have applied to both Orthopedic Surgery residencies and Traditional Rotating internships in case I don't get into an ortho program. The traditional path of medical education was to finish med school, do a generic internship year rotating through all major specialties, then do residency. Some residency programs, ortho included, have wrapped an internship into the curriculum as the first year of the program, and therefore take one step out of the process. My interview offer is with one of the internship programs, and the most convenient available interview date is this coming Monday. So, I had a flurry of activity booking a flight and hotel today. Thankfully the airport, hotel, and hospital are within a 3-mile radius of each other, so transportation is easy. Unfortunately, booking a 36-hour trip only five days in advance is pricey, and all the numbers are starting to run through my head: several hundred per interview trip, times 23 programs applied to, subtracted from what remains of my student loan for this semester... ugh. I'll be panhandling by November.

Scott