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ACEP Now: Vol 38 – No 03 – March 2019

ILLUSTRATION: Chris Whissen & Shutterstock.com

I turned 18 in the emergency department. The charge nurse surprised me with a cake, and as the clock struck midnight, I celebrated my entry into adulthood, and legal overtime, with my emergency department family.

I began work as a scribe roughly two weeks after I graduated from high school. I suppose that I, more or less, grew up in the emergency department. My father was the medical director of our local department, and I was quite familiar with afternoons spent at “Daddy’s house.” My first shift in the emergency department was filled with sheer excitement rather than nervousness; I was finally working among the heroes. I had so much to learn! Over the course of four years and 4,500 hours in our hospital, I would forgo many other life events. I have no regrets; working is learning, and learning is addictive. Each shift and each physician brought a new set of skills and life lessons. Scribing reaches beyond thorough documentation and increased efficiency. It has become a necessity to both emergency departments and aspiring premed students. As time goes on, their mutual reliance and integration will only increase.

My favorite emergency cases occurred outside of the emergency department. When a good friend crashed his vehicle and laid unconscious, not breathing, it was an emergency physician who met him on the side of the road and provided lifesaving interventions. When a local house collapsed down a mountain and rescue technicians rappelled into the rubble to ensure that children had not been present, it was an ED doc they had waiting on standby. An emergency physician provides their community with the best when they are experiencing their worst. Through these circumstances, I saw that emergency medicine reaches outside of the walls of a hospital and, perhaps, could be the practical field I had dreamed of.

As a scribe, I learned many lessons that prepared me well for medical school. I saw firsthand how to approach a patient with objectivity and deductive reasoning to narrow the differential diagnosis, and I learned how to develop a plan of care based on those considerations. I know the value of thorough documentation, and I am familiar with many of the charting regulations (ICD-10). When I’m faced with a “challenge question” (eg, “Will I need surgery?” “Do I have cancer?” “Am I going to die?”), my professors are always impressed with my emergency medicine approach, encouraging the patient that they are in the right place and we will work together through the history and physical exam to get them to the next correct place.

At times, scribing went beyond documentation. I often assisted in log rolls and other activities that helped the transitional processes for an emergency department to run more smoothly. I am convinced that manipulating a wheelchair and driving a hospital bed should require a license. Other times, I found ways to implement my skills as a scribe outside of a chart. During codes, I often grabbed a marker and recorded times of medications and procedures on the room’s whiteboard. I learned to spike fluids and fetch a crash cart. I became part of a team and tried to use my time to fill in the gaps.

Truthfully, I trailed my physician and tried to provide any assistance required. This path took me all over the hospital. I remember the feeling in the pit of my stomach when we walked into the morgue to attempt to draw blood from an exsanguinated patient. I remember the fascination of suiting up in lead for a cardiac catheterization lab intubation, and I remember joy when the stent was placed, seeing the dye once again wrap around the myocardium. I remember the sadness of helping clean up a room after calling a code, and I remember offering coffee to the family in a desperate attempt to provide some form of comfort as they sat with their lost loved one. I spent hour upon hour in exam rooms, cringing at the sight of chest tube placements and the sound of bone drills. I learned to identify Clostridium perfringens from Clostridium difficile simply by smell, and I learned that, sometimes, opening a bag of coffee can help with those smells!

To the physician, I was an extra set of eyes that noted a bruise here, swelling there, or clear fluid draining from an ear in a trauma patient. I was the one who wrote down “left” versus “right.” Often, there were things that the physician picked up on that they did not state aloud. These things appeared as gaps in the history, but through inquiring about those details, I learned that you can glean a lot of information without speaking.

While I have gained invaluable clinical experience, the most valuable lessons came from the doctors themselves. Through simple observation, I learned how to break bad news with honesty and tact. I learned to remain calm and collected in the face of urgency. I sat with souls as they slipped from this earth, and I watched soon-to-be parents receive the news of their pregnancy. I saw that a kind word and small act of service can mean the world to someone.

I gravitated most to the physicians whom I found to be willing instructors. Though I came out of my first ECG introduction remembering only the letters “PQRST,” I had identified a teacher, and I followed his lead (and his shifts). Often, those willing to take the time to pass along wisdom were also willing to spend time with their patients and the staff. They got water glasses and pillows rather than recommending an aide for the job. Difficult diseases were explained in colloquial terms, and families were allowed to ask questions. They fought for a patient’s best interest while still retaining respectful professionalism with peers.

The most valuable thing you can do as a physician is to demonstrate the role of a physician. Be a healer, teacher, and leader. Be astute and analytical and show a propensity for lifelong learning. Be correctable, willing to admit mistakes, and take time to teach those following you all the lessons you’ve learned. You never know—you just might influence a young kid like me to follow in your footsteps.