Back of the Rig

The page read, “Where are you? I thought your shift was beginning a few minutes ago.”  I was starting my two-week shift in the Emergency Department.  I had already hit the hospital, but was grabbing some sustenance, as the ED is notorious for tough shifts without a break to eat.  I ran into the ED to begin the endless night of triaging one acute emergency after another.

Internists are notoriously slow when they work in the ED.  We are considered the “thinkers” whereas the Emergency Room physicians like to be considered “the doers”.  We like to take our time with patients, carefully working them up, getting a thorough history and presenting it to the attending docs in a calm collected manner.  Meanwhile, our ED colleagues are more than happy to be suturing someone’s wound, or perhaps intubating their roommate.  While it benefits all of us to get experience on the other’s turf, there is always a certain apprehension that one feels entering the controlled chaos of the ED.

Usually, when I am on a medicine floor, I arrive a good 1-2 hours before the rest of my team who show up at 7:30AM or 8AM.  As interns we are expected to “pre-round” on all our patients.  “Pre-rounding” essentially entails getting vital signs, being clear what medications the patient is taking, getting information on any overnight events, and of course, examining the patient and trouble shooting any emergencies.  We do not do shift work.  We work until everything is complete, and it is rare that we comfortably sign off “scut work” for others to do.

In the ED, we are working specific set shift hours.  We are required to be there the minute a shift begins and leave after it ends. In stark contrast to our usual life, where we wander the pre-dawn halls of the hospital in solitude gathering information, there is a room full of people waiting for us to arrive in the ED.  Our job is to be there to move the endless stream of patients to their appointed destinations. 

Despite the better hours during a block in the ED, we are out of our element as internists.  We have been known to locate the 1 or 2 other internal medicine folks in the ED and glom onto them, deliberating differential diagnoses on patients that are destined not to be our own.  The job of the Emergency Room physician is to triage patients, deciding who can go home and who needs to be admitted.  They need to think fast, move quickly, and get a patient what they need ASAP.  Ultimately, the patient is someone else’s responsibility.  This process of endless triage can be very disorienting for an internal medicine doc, who likes to read the full text of the book, not just the intro. 

It was during the heat of the moment, when I was running from one ED shift to another, like a fish out of water, that I lost all sense of normalcy.  Perhaps I am now rationalizing my behavior, but the link between the ED and the ambulance seemed like an obvious one at the time.  After all, if others could arrive in the ED in the company of paramedics, why couldn’t I?

The two paramedics were parked on the side of the road eating their lunch waiting for their next dispatch.  I ran towards them in my scrubs waving my hospital ID.  “I need a lift, now!” My voice was authoritative, but fear was lurking underneath.  I was merely a few minutes shy of getting the “You are 5 minutes late” page and still miles from the hospital.  They were the only transportation I could find.

In the end, my friends gave me hell for getting a ride in the back of the rig.  My response has been simple: “Anything seems logical when you are pulling a shift in the ED.”  My grandfather may have spent time riding in ambulances while in training to become a surgeon 50 years prior, but this was likely to be the only time I would be offered a free ride.

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