Week 5-Marsha (Last Week)

            My last week of summer immersion was all about completing as many clinical rotations as possible. Monday: Cardiothoracic surgery. Tuesday: Lab. Wednesday: Emergency Department. Thursday: Medical Intensive Care Unit (MICU). Friday: Neonatal Intensive Care Unit (NICU). While each experience was unique, I think the emergency department will be one of the most memorable experiences of the summer.

            Since I had never been a patient in the emergency department, I didn’t know what to expect and in my mind was envisioning typical television dramas. Well, let me begin by saying real life is different than television. Over the course of the day there were two high alert patients where doctors, residents, and nurses rushed to the intake room. Aside from that, most patients did not have acute ailments. They came in because of some inexplicable feeling of discomfort—illness, digestive, or other, but were not in a life-threatening state. With the exception of the acute cases, the doctors and staff monitored patients at a calm pace, not frantically as I had anticipated.

            My memorable case was a sickle cell anemia patient. I learned about the challenge of pain management in sickle cell anemia from a physician’s perspective. Pain is one of the most common symptoms of sickle cell anemia and severe pain can be managed at the hospital using therapeutic drugs. In theory, every patient should be allowed to come into the hospital and receive unbiased treatment for their symptoms. Especially, in the case of sickle cell anemia where the pain is well documented and IV drug administration is the status quo. However, the situation becomes complicated because after a lifetime of morphine, Benadryl, and other drug administrations the line between patient and drug addict can become blurry. Should a physician be able to tell someone yes they can receive medication for their pain or no they cannot? How do you know if a patient is really telling the truth. After administering a combined pain treatment to a particular sickle cell patient, one of the attending physicians was explaining to me the challenges of treating these types of patients, and expressed that he really believed this patient was in pain. Two hours later, it was revealed the particular patient had been to the emergency department 28 times over the past 6^th months using different names and birthdays. When confronted by a social worker, they got up and left—of course having already received their treatment. This particular patient really highlighted the challenges that even the most experienced physicians face when trying to elucidate what is fact and what is fiction when talking to patients. It was also a good “last week” scenario because it showed the continued need to improve both diagnostics and treatments in medicine. We as a medical field are not doing a good job if our treatments turn patients into drug addicts.

            As a whole, summer immersion was without a doubt a once in a lifetime experience. Watching surgeries, rounds, and office visits I gained a better insight into how physicians think and the environment in which new medical advancements would be implemented.