Greetings to all new emergency medicine interns. Your residency program signed you up for a free monthly magazine you lucky dogs. Now that you are committed to emergency medicine, I figured I should bestow some grandfatherly advice which I learned from reading “House of God.”
Explore This IssueACEP News: Vol 32 – No 09 – September 2013
If you have never read “House of God,” by Samuel Shem, go read it right now. You’re back? That was quick. Well done.
In “House of God,” the Fat Man outlines the rules to his naïve and eager protégé, who quickly learns the wisdom of knowing when to do nothing and when to act (in that order). In the complex and constantly changing environment of the ER, you must have a method to maintain your sanity
Here are some tips.
Thus, with my apologies to Dr. Bergman (Shem), I give you the Five Rules for the ER.
Rule 1: Panic later.
Have you ever seen single digits on a pulse ox? How about someone rushed in through the front door after being shot? How about an apneic neonate? This is the time to act, not the time to flip out.
We have all had sphincter tightening cases. However, the second you let that demon of distress and panic take over, you have lost the game. Even when the colostomy bag hits the fan, never let it show. Why is it so important to stay calm? Think of famous meltdowns. Who do you want to be? At the end of “Christmas Vacation,” Chevy Chase, who rants at to his boss at the end of “Christmas Vacation?” Or Cameron, who crashes his father’s Ferrari through the garage in “Ferris Bueller’s Day Off?”
Sometimes, I feel like Adam Sandler in “Happy Gilmore.” I just want to scream at my patients, “Get in your home! Are you too good for your home!?” You need to be Jules from “Pulp Fiction,” telling Honey Bunny to be like Fonzie. What is Fonzie like? Cool. You want to be the hero at the end who keeps walking away with his shades on despite the giant explosions. You do not need to look back at the explosions; you can panic later.
Rule 2: When in doubt, you might want to look at your patient.
Every emergency physician has had crazy-busy shifts where someone just does not seem to improve. During these shifts, sometimes labs and orders get thrown in with a cursory exam (or sometimes a fly by the room on your only trip to the bathroom in six hours). Despite a slew of negative lab work the nurse says the patient looks worse. Still want to discharge her?