Week 3 - Marie

An 8-hour shift in the Emergency Department (ED)was definitely the highlight of my week. I shadowed Dr. Joe Rella, an attending physician in the ED. What was most interesting about this experience to me was seeing the process of taking a patient's history and peformin a physical exam-- most of my experiences in the hospital so far have occurred after the patient's health concerns are well-known, but in the ED this is often not the case. For example, one woman came in to the ED complaining of chest pain. Dr. Rella's line of questioning included her medical history, her parents' medical histories, her lifestyle and diet, her work and associaed stress, etc. From this we learned she was a middle-aged woman with a high-stress job in social work who smokes and drinks 6+ cups of coffee a day, and has a history of lupus and high choleserol. This led Dr. Rella to consider both cardiac and gastrointesinal sources for chest pain, which he assessed with serial blood work. This case demonstrates a few other challenges of the ED: triage means that some patients can wait for a long time, high occupancy means many patients are in beds in the hallway, serial tests (often necessary to look at changes in serum levels) mean patients are at minimum frustrated (and sometimes irate). I was impressed, however, with the continued professionalism of the ED staff, and greatly appreciated how much time Dr. Rella made to explain the various x-rays, MRIs, and EKGs that he had ordered for his patients. I plan on spending more time in the ED this summer, both in the A section and with the triage nurses.

Another interesting part of my week was the imaging seminar given by Dr. Prince. Dr. Prince used case studies to teach us how to read medical images--for example, the first slide featured an x-ray of an arm demonstrating a "nightstick fracture", which is an isolated ulna fracture. This slide was fairly easy to identify, but the images became increasingly difficult, ending with two fetal MRIs. These seemed quite challenging at first, but we were to discern health concerns such as previa and encephalocele. These MRIs were follow-ups to concerning ultrasounds and are used to determine the type of birth and to prepare the medical team to quickly act.

I attended the gynecologic oncology tumor board meeting this week, which is where the team of gynecologic oncologists, pathologistics, etc. meet to discuss common patients and determine courses of treatment. I also attended the pediatric grand rounds on Tuesday as well as part of my Pediatric ICU rounds, during which fellows presened their research.