As our plane descended into the mist of clouds swirling over small towns and rice paddies I was flooded with a mixture of feelings that went all the way back to my teen years. As the nation convulsed over our involvement in Vietnam, my only concern was where my birth date was going to fall in the draft lottery. 357. My eyes had to scan the newspaper three times before I found it. I couldn’t believe that out of sheer luck, call it Providence, I would be sitting this one out. But many of my friends weren’t so lucky.
“I think he’s sick,” my wife said raising her voice while stepping between me and the TV. She shoved our little chubby boy towards my face. He had just the slightest gray cast and the soft stridor that was left after was beginning to show respiratory fatigue. It caught my breath.
"I see where all this money is going. It's going to pay for all the bogus medical problems that I see every night."
“It’s official,” I called out to my wife from my computer. “Emergency physicians have more sex appeal than surgeons!”
“Don’t believe everything you hear about research, even from me.” It was a great line to end an outstanding lecture on evidence based medicine. Everyone laughed and began standing up as the lecturer called for questions. I thought he was going to get a standing ovation. But no one went to the microphone.
I love it when the lecturers say the same thing. “Take a good history…” They act as if we don’t know what questions to ask. Don’t they get it? The right questions are all written out on the template. Sometimes I just don’t know what to do with what the patient tells me. Ever had one like this?
“How was your night?” my wife asked as I trudged into the house. I just wanted to go to bed, but the smell of the coffee beckoned me towards the kitchen. Just one cup, I thought.
“It was good for the patients, but bad for me,” I said, shrugging my shoulders.
Everyone has them. Some won’t admit it, but everyone has a situation or procedure that, even though they’ve done it a thousand times, they avoid as often as they can. You’re supposed to feel comfortable performing these procedures, but you feel just the opposite. For me, and I’m embarrassed to say this, it’s rectal exams.
It was 8 a.m. on July 1 at the Maryland Institute of Emergency Medical Services, or ‘Shock Trauma’ as it was known locally, and the shift was supposed to be over. But I was still finishing up the last few stitches of a semi-open peritoneal lavage on a guy who had run his motorcycle into something very hard. As soon as the other members of the trauma team saw that the returning fluid was clear, they all ran for the door. “Let’s take a picture,” I said. “It’ll be our ‘graduation photo.’ The attendings are already gone. We are the last rats to abandon the ship.” The remaining residents gathered around the patient, using him as a rather grisly backdrop.
The story I’m about to tell you is completely true. But the names have been changed because, well, you’ll see. I’m sure you guys who are now entering the established field of emergency medicine cannot begin to fathom EM prior to 1979, but here’s one for the books.