August update

Still here, still alive.

This weekend, Brian and Sam are in Oregon, throwing rocks into the Rogue River and catching up with old friends. I'm in the middle of a run of night shifts in the emergency department at our university hospital, so I got left behind. What this means is that, for the first time in over a year, I have an entire day to myself.

Sleep until I wake up, check. Coffee and the NYT, check. Pedicure, check. Eating ice cream in bed while I update my blog, checkity check.

Emergency medicine has been an interesting experience so far. As a medical student, I felt reasonably certain that the specialty wasn't for me, so I didn't bother to do an emergency rotation; this month is my first exposure. While my time so far has confirmed that emergency medicine isn't a fit for me (noisy, chaotic, waaaaay too much psych and OB), I'm enjoying myself. Nice people, interesting cases, shift work.

Last night I met a 59 year old woman who was billed as "headache, vomiting" and triaged to the less-acute area of our department. I strolled in, expecting a migraine or maybe meningitis. But from the doorway, it was obvious that my patient was much sicker than advertised. She was slumped to her side, shuddering and moaning. Three hours earlier, her son explained, she had argued with a neighbor, then been struck suddenly with an overwhelming headache. She fell to the floor, unable to stand or walk, and proceeded to vomit again and again. When I met her, she no longer recognized her son and she couldn't look at me, answer any of my questions, or participate in my cursory neurological exam. After surveying the scene for about a minute, I had heard all I needed to hear; I called a stroke code and 10 minutes later, I was standing in the control room for a CT scanner across the hall with the on-call neurologist, looking in horror at images of a brain filled with blood. We wheeled our patient back to the emergency department, pushed mannitol and 23% saline to prevent her brain from swelling, then waited for the on-call neurosurgeon to make his necessary arrangements. I suppose it's a sign that I don't belong in the emergency department that when my patient left for the operating room -- no longer my patient -- I wanted to go with her. To be sure, I am not the doctor she needed that night, but it doesn't sit well with me to triage and stabilize, then hand off care for my patients to other physicians. I'm glad I'm not an emergency medicine resident.

On a happier note, here are some pictures of Sam at the science museum in San Francisco.