Medical jargon drives me crazy sometimes. It makes sense to use with other health professionals who will know what you’re talking about. It facilitates communication in certain situations. With patients though, it seems to just get you in trouble, or make you look like a fool.

A focal neurologic deficit as I understand it is a deficit that is affecting a specific part or side of the body. Right sided weakness, a facial droop on the left side, or right arm numbness would be examples of a focal neuro deficit. Focal designates that the symptom is in a specific area.

Most people don’t know that, heck, it took me many months to figure it out working as a scribe.

So, naturally, it was surprising and frustrating when a physician I was working with asked a drunk guy coming in complaining of weakness-

“Do you have something focal going on? Anything focal?”

Wow. I think the blank stare would have been the response of 99.5% of the population in a similar situation.

Note to self: never ask someone if they have something focal happening to them, unless my patient is a neurologist.

A while back I was working with a physician and we had just seen a psychiatric patient. Someone had pointed out to me how it was dumb to have the psych rooms so close the pediatric side of the Emergency Department. I decided to bring this up with the physician, in hopes to stimulate some conversation. There’s nothing like complaining about something to find some common ground, right?

So I mentioned it. His response was not what I was hoping for. He kind of half agreed with me, seemed uncomfortable, then justified why the rooms are there. It was awkward. So I didn’t bring it up again.

Later I realized I was working with the director of the Emergency Department. Oops.

He probably has big role in designing the layout of the department. In criticizing the placement of the rooms, I was also criticizing him.

Sometimes I think I’m an idiot.

While I’m Scribing, it is key for me to understand exactly why the patient is in the ER and provide an accurate history describing their illness. This is often difficult as patients are often terrible providing a coherent history.

Thus leading to this post by Ten out of Ten, outlining many different types of patients and how they mess up such a simple task. Ten states, “Maybe 1 patient in 10 manages to concisely describe their issue and stick to yes/no answers.”

The post is incredibly entertaining and it’s worth taking the time to read the whole thing. Beware though, you may find a bit of yourself in some of these descriptions. Here are a couple of my favorites:

Me: “Do you take insulin or pills for your diabetes?”
Patient: “Well, at first they put me on a diet, and told me to exercise, and I did for a few days anyway and at first it seemed like maybe it helped a little bit, but then I guess it got worse, so they put me on a pill…what was it called…metop-o-nin…metamucil…formethorin…no…metlife?”
Me: “Metformin.”
Patient: “Yes! Metformin! So anyway they put me on that at first and I was getting it filled and then there was a problem with my insurance so I had to switch to a different pharmacy and that one was way farther away and the people there were not nearly as nice, except for Lula although now that I think about it she didn’t even work there, she worked at the Marshall’s across the street — I think it was a Marshall’s, either Marshall’s or Ross I can’t remember, which reminds me I need to take those shoes back, um, so…uh…where was I now?”
Me: “Um, insulin or pills?”

Wanderers are the worst. I usually end up afraid to ask any more questions and cut the conversation short.

Me: “Have you had fever?”
Patient: “No, but chills.”
Me: “Vomiting?”
Patient: “No, but I feel like I need to.”
Me: “Surgery on your belly?”
Patient: “No, but I’ve had my tonsils out.”
Me: “Heart problems?”
Patient: “No, but my mom’s a diabetic.”

The no/buts cannot bring themselves to stop at no. Do I need these extraneous details? No, but my knee is a little achy today.

Have I ever read a post so entertaining? No, but my memory is a little hazy today.

A few days ago we received evaluations from doctors we have worked with. Most of the ER Scribes on our team are new this year and have worked for about 6-7 months, and this was the first time we received any feedback since training.

Here is what one of the doctors wrote on my eval:

“One of my favorite scribes! Reminds me of myself 12-15 years ago.”

What a nice thing to read. It helps that it was from a doctor that I like and respect.

Anyway, it was great to get some feedback. I feel lucky to have this job.

I was excited. The ER Scribe position is a dream job for a pre med student. When I first researched the position, I could hardly believe it. You mean you get to follow around ER doctors, take notes for them, keep track of lab results and xrays and cat scans, and you get paid for it? Sweet!

So yeah, it was my first day and I was excited. Like, first date kind of feeling. Apprehenisive, nervous, but looking forward to it.

I’m supposed to be at work 45 minutes before the shift so my trainer can orient me a bit. I give myself about an hour and 15 minutes to get to work. The shift started at 6 PM, so traffic would be an issue, but I figured that would be plenty of time. Wrong.

An hour and 45 minutes later, I screech into the parking lot, slam the door shut and run towards the hospital. I’m sweating because it’s summertime, my car doesn’t have air conditioning and I’m nervous as hell. I meet my trainer (I called and let her know I was running late) and we rushed to get me changed into some scrubs. While I’m late for our orientation, if we hurry at least we won’t be late for the shift to start.

10 minutes before the shift starts. My trainer is giving me a quick tour of the ER and we’re looking for a COW (computer on wheels) simultaneously. Of course, I’m working at the largest ER around, with 4 separate sections. I have no idea where I am.

5 minutes til the shift starts. We’ve found a COW. My trainer has signed into the charting software. The doctor we’re working with shows up and we meet quickly. Then, our first patient of the night shows up.

CODE! I don’t know what that means, but apparently it’s bad. Chaos surrounds me. The paramedics are rushing in, a billion nurses are hovering. My keen observation perceives that a code is a big deal. We follow everyone into the room. I do my best to stay out of the way. The doctor looks at me and says, "We need to get records from _____Hospital!"

Uhhh. Ok. Luckily my trainer saved my butt and points me to the unit secretary, "Go ask her."

I walk up. She seems intent on something. "Uhhm. So, yeah." I sound like a bumbling idiot. "I guess, we uhh, need records from-"

"Already on it!" She says curtly, cutting me off. She has subsequently become my favorite unit secretary.

All I remember about the patient was that he was unresponsive when he first came in. The rest is a blur. I think he survived. The rest of the shift was spent attempting to absorb globs of information- medical terminology, how to work two separate charting software programs, where room 14 is located etc.

All that to say- my first day was kind of rough. But I loved it.

(Photo Credit)

Yes, and yes!

My position as a an ER Scribe has vastly increased my medical vocabulary. I can name (and spell!) countless medications, and I generally know what they do.

This hasn’t proven especially useful outside my work until this week when I was watching the show “House”.

Here’s the situation: a guy is holding House and a bunch of other people hostage demanding treatment for a disease that no physician has been able to diagnose. House quickly analyzes his symptoms, diagnoses him and says he needs Propofol.

So I’m thinking, “Propofol… how would that help… oh I get it!” You see, Propofol puts you to sleep. We use it in the ER all the time when we’re resetting fractures or dislocations. House was trying to put the guy to sleep, and I knew it!

You have know idea how much pleasure that brought me.

Well, if you watched the show, you know the outcome. The hostage-taker demands someone else take it first, and this poor soul promptly passes out, much to the chagrin of House. Some other crap occurs, people get shot, one of House doctor’s almost dies and other silly things happen. It was actually one of my least favorite House episodes ever.

Except for that moment. For that moment, I knew I was ahead of the general population. I knew what was going to happen, while most people did not.

So naturally, I had to brag about it on the internet. Happy Friday everyone!

"Ten out of ten? Really? Is this really the worst pain you could possibly imagine?"

"Wow, this person has been in the ER 15 times in the last three months. You know what that means."

"Where are the normal people?"

These are just a sampling of the kinds of thoughts I’ve been having lately during my job as an ER scribe. These cynical thoughts are bothersome.

What’s even more bothersome is the lack of compassion I’m starting to develop. Seeing people in pain used to surprise me. I would feel a certain amount of empathy for someone in obvious pain. But it’s so common, and it’s so hard to differentiate between who is actually in pain, who is exaggerating their pain, and who is not in pain at all. I don’t know what to feel.

When I first started working, the psych patients were the cases that bothered me the most. My own family history has made me aware of the difficulty and complexity involved in mental illness. But I’ve noticed a disturbing lack of care

Why is this happening? I’ve only worked in the ER for four and a half months. Why do I suddenly feel so cynical and jaded?

Part of it is obvious. I’m just mirroring the voiced thoughts of those I work with.

However, I do wonder if it is a product of my specific role in the ER. I see every patient the doctor sees, but I do very little in the actual treatment of those patients.  Some doctors don’t even introduce me as I enter the room. Indirectly I’m helping these patients by allowing the doctor to spend more time with them face to face, keeping the doctor informed of incoming lab tests and imaging studies, and making sure they get informative discharge instructions. But x-ray techs have more interaction with patient’s than I do.

Maybe this lack of connection with patients helps contribute to my lack of compassion. I don’t want to make that an excuse though. The change in my thinking has been startling as I look back on how I thought in the past. I want to do something about it.

I’m curious to hear from others who work in health care. How do you deal with this issue? Can you give me any advice?

I guess I’m trying to integrate a realistic world view with a compassionate one. I’m faithful that they can co-exist, I’m just trying to learn how.

I’ve worked as an ER scribe for a little over two months. I’m often asked, “How’s the job going?” or “What’s it like in the ER?” I usually rattle off an interesting story, or talk about how difficult and stressful the job can be at times (it is getting easier though).

But no matter what I say, it’s difficult to truly capture what working in the ER is like. It’s a completely different world. It’s a world I’ve never been exposed to. I’m only just beginning to understand how things work, and why things are the way they are.

A post over at ER Stories has helped me understand much of what I’ve been seeing. The author describes life from the perspective of an ER doctor, and it is an amazing description. It’s long but worth reading. Here’s a quote:

“Simply put, if you have not spent any significant time either working or volunteering in an ER, you really don’t know what it is like. People are at their WORST in the ER. Sometimes it is because they are sick or a loved one is sick. Sometimes it is just their true colours coming out. If many of you extremely touchy-feely types actually had to work a shift in the ER you would probably want to kill someone. Why? Because you don’t realise it but much of the population is either nasty, manipulative, violent, malingering, antisocial, and or disrespectful. Of course the majority of people we treat are not, but I guarantee if you have to deal with even 4-5 out of the 20-30 you might see on a given shift, you will re-think things. Imagine getting threatened by people who you are trying to help. Getting spit on. Getting told what do by people who don’t know anything about the practise of medicine except what they read on blogs or in newspapers. Witnessing the gross indifference people have for sick loved ones. Witnessing child abuse regularly. Dealing with intoxicated persons who want to kill you. Listening to people bullshit you about their medical conditions so they can either get out of work, get disability, or get narcotics (often for resale). Imagine getting zero respect from people for the years of training you have.”

Read the rest of the post here. It is worth your time. It not only provides insight into life in the ER, but also to the practice of medicine in general.

I mentioned to a friend the feeling of numbness that develops while working in the ER. It hasn’t always been present for me, but often I have been so overwhelmed by what was going on around me, that I felt completely numb. The nurses and doctors seem numb as well, but it’s not because they are overwhelmed. I don’t know if it’s a good thing or not. Emotion can cloud judgment, but isn’t the reason most people become doctors is because they care about people and want to help them?

My friend said that I should ask a doctor about this.

I haven’t had the chance to talk with a doctor or nurse about that feeling of numbness, but I’ll try and ask if I can. I see it all the time though. It’s frustrating. The doctor is always leaving the room abruptly, their mind on the next task. Often they seem to miss the fact that they are dealing with someone who may be very scared about what is going on, and a simple word of comfort (like , “we’re going to figure this out”) would make them feel a whole lot better.

I’m always struggling with this desire to say something like that when I leave the room, but I’m really not supposed to, plus I have no idea exactly what I’d say. Plus I’m really not involved in what happens to them at all, so any word of comfort I may say would sound hollow. And then my rational side says, what does it matter if we make the person feel better for a little while, is that going to make their illness go away? Shouldn’t a doctor be focused on the task at hand, helping people get physically better and not waste time worrying about their emotional well-being? I don’t like that, but I could see a doctor saying that to me.

And I’ve seen doctors who do both very well.  I think that is ideal. And yes, those doctors tend to be female.

Greater emotional awareness?  What do you think?