He was 5, and had been turned away from 3 different ER’s over the last month. Undifferentiated stomach pain, vomiting after eating, generally listless. We reviewed the charts from his previous ER visits and nothing stood out. Blood counts, electrolyte counts, liver and pancreas functions, all normal.

He looked almost dead to me when I first saw him. His eyes were unfocused and vacant, skin pale, stomach distended and grotesque, lips chapped and cracked. His younger brother, wide-eyed, was sobbing inconsolably. Mom and dad both seemed detached, as if this was just another hurdle they had to get over. Get through the terrible two’s, go to daycare for the first time, get admitted to the hospital. Grandma, on the other hand, had a look on her face that bespoke grief and fear. Aside from the docs, I think she and the brother were the only two who realized how serious things were.

Our workup revealed the worst presentation of Burkitt’s lymphoma any of the docs on service had ever seen. Over the course of the next week he fell victim to intestinal resections, a splenectomy, rounds and rounds of chemotherapy, and steadily worsening vital signs. He was put on a mechanical ventilator after day 2 of his hospitalization. He looked scared when I went in to say hi.

The grandmother cornered me the day after his admission, her face stained with tears and exhaustion. I’ll never forget the words she spoke to me - “Please, doctor. Just tell me my grandson will live. I love him so much… he is my angel”. She was begging for a ray of hope that I could not give.

I looked at her for a few moments, and finally said the words I never thought I would hear myself speak. “I hope so, but the cancer is bad, and it is spreading. I can’t promise that he’ll be ok, but I can promise that we will do everything in our power to save him”. I meant it. He died a week later.

A good friend just sent me this link, which lists 10 things that should make you think “hey, my personality fits ER!” To steal an excerpt from Dr. Hayward’s article (originally h/t Desperado on the EM forum):

1. The Emergency Physician (EP) sees his profession as a job, not a calling. You will notice in your medical school class that there are those who live, eat, and sleep medicine. Those people typically do not go into EM. EPs typically have many outside interests, and are interested in a job that allows them to pursue those interests as well as medicine.

2. EPs love working up undifferentiated complaints. They got upset in their third year medicine rotations when they were told to go down to the ED and work up the guy with the COPD exacerbation. They wondered, “If I already know he has a COPD exacerbation, what’s left to work up?”

3. EPs think a doctor-patient relationship is what you have when someone gives you a chart with a patient’s name on it, not what happens after following someone’s hypertension for 10 years.

4. EPs like to do procedures. They think sticking people with needles is fun.

5. EPs aren’t afraid to make a decision on limited information.

6. EPs like to work as a team. They know what their nurses do outside of the hospital, and nurses call them by their first names.

7. EPs like to multi-task. EPs prefer to work while they’re at work.

8. EPs prefer a specialty of breadth to a specialty of depth. They enjoy learning practical information, and using common sense.

9. EPs enjoy being able to take care of people from all walks of life, rich, poor, old, young, smart, stupid, etc., without having to worry about whether they can pay you.

10. EPs typically enjoy a large percentage of their medical school rotations. They often think psychiatry is interesting, just not necessarily something they’d like to do all day. They enjoyed surgery, they enjoyed ICU, they may even have liked OB/GYN. They usually liked internal medicine, but detested rounding for hours and writing 10-page-long notes.

Interestingly enough, I have verbatim spoken the words in #2, #4, and #10… and paraphrased every other one at some point in my career. If you’re considering Emergency Medicine and want to read more, I suggest reading the rest of the article.

Awesome! I’m off to go put in a 2 hour ’shift’ on the bike… later gators.

Alright, I’m going absolutely batshit stir-crazy† on radiology. Yeah, it’s interesting. Yeah, it’s fascinating. But seriously, they just sit down in that dark room, isolated from mostly all human contact, and read films all day. Good lord, I’m about to lose it. Also, sciatic pain is resurfacing from sitting all day.

ED starts in 2 weeks. Woo!

†Welcome to the roller-coaster ride that is Zac’s emotional state. Some of you are more familiar with it than others :)

A 40-something female presented to the ED a few days after having her gallbladder taken out for infected stones. Keep in mind, this is a teaching hospital in July, so the surgeons are pretty new at this. Hopefully there’s an attending helping them out, but you never can be too sure.

Of course this woman gets admitted to the hospital, because now she’s got a post-operative fever, high white blood cell count, tender abdomen, etc. etc. etc. Naturally they get a CT to see what’s going on…

The surgeons had accidentally cut through the gallbladder, releasing all of her infected stones into her abdomen†. And then for some reason, they just left them in there. Maybe it added to the feng shui of the abdominal walls, I don’t know††. I imagine it went a little something like this:

Intern: Making the first incision now… I’m grabbing the gallbladder.. annndd…. oops.
Attending (turning around): Was that an oops I just heard?
Intern: Uhh, it was nothing, sir. I just jiggled the camera a bit.
Attending: Very well, carry on.

†BTW, when I’m a resident I’ll start carrying a USB drive with me so I can start posting images to go along with the stories… I’ve been trying to figure out how to keep this blog going if I end up doing rads.

††Zing! Puns just never get old.

Well, folks, I’ve made up my mind (mostly). It’s either Radiology or ER at this point; I’ve found Rads so interesting that I’m actually *gasp* inspired to write a personal statement about it. Shocking, I know!

We’ll still have to see if the aforementioned pandemonium of the ER gets me going… but honestly I find the visual aspect and the breadth of Radiology really works for me. Our program is a bit… quiet for me (I’m a fairly loud person, as most of you know) but the residents are really chill and it’s undeniably cool stuff.

More to come!

Edit (9:45PM): Well, that was fast… done already! I gotta be honest, personal statements for residency are a whole lot easier to write than medical school… you’ve actually DONE the thing you’re applying for :-)