Just like on TV

I was pontificating on the differential diagnosis of a 'worst headache ever' with my preceptor . . . sub-arachnoid hemorrhage, encephalitis, stroke, cluster headache, mass effect . . . when one of the other emergency docs pops his head in the door.

Hey, there's a witnessed arrest coming in in v-tach, this would be as good one for you.

Oh, great! The words pop out of my mouth perkily without processing them.

Gown, gloves, and I stroll into the trauma room following paramedics, nurses, a respiratory therapist and two emergency docs. Standing at the back, observing, seeing what I can learn from this demonstration of the efficiencies of our wonderful medical system. Until the doc gestures at me to get to the head of the bed and thrusts the laryngoscope into my hand. Say what?!?

Have you intubated before?

Yup. Which is the truth, in fact, prior to this moment, my intubation success rate is 100%. That is, in the OR, with no stress and lots of time.

Our 'v-tach lady' had collapsed directly onto her face. A purple goose-egg was starting to swell up on her brow, her nose and chin were scraped and her front teeth loose, jutting out at strange angles and bleeding. Also of note, she had no neck and a receding chin. This combination is any doctors nightmare. It means that the magical smooth intubations you see on ER are in no way possible. And yes, its me currently holding the scope, not an ICU doc, not an anesthetist who has done thousands of these, and certainly not Noah Wyle, just little old me.

Okay, its a one shot deal. Go for it. 'Enough with the drama,' I silently say to my attending.

Metal blade slipping across the tongue, I haul on the handle desperately trying to see anything remotely resembling those golden vocal cords. All I see is blood and tongue. The sickening crunch of metal on teeth as I inadvertently preform a dental extraction and the nurse removes the loose tooth so it doesn't get in the way. When you learn this on the model in med school the head makes a little beeping sound when you lean on the teeth too hard . . . no such warning beep here.

Suction please. I can't see anything. Sluuuuuuuurrrrrrrp.

The emerg doc takes over, tries twice. Eventually getting in a bougie to thread the tube into place. He said it was the worst intubation he'd ever seen. Which didn't make me feel so bad.

I'm under the impression that the emergency department is great fun. Probably because I'm not the one who's really responsible for the patients in the end. But like any rotation there's the good that bad and the ugly.

The good. I got to sew a nose back together that had been sliced cleanly by the knife of 'This One Guy' at 2am when the patient had just been minding his own business out on the street.

The bad. I've had to do a significant amount of DREs (digital rectal exams . . . where the digital part has nothing to do with a Nintendo Wii . . . Wee.)

The ugly. My first ever 'trench foot' experience. Named after what happened to soldier's feet in the world wars from walking around in wet trenches for months on end. To describe it would be too traumatic for all those involved. Smell. Rot. Geeahrgh.

One thing I have learned: if you have friends called 'This One Guy' or 'That Bitch', don't give them your PIN number/welfare check/go drinking with them because they will without a doubt take off with your money/slice your nose open/sleep with your best friend/steal your drugs. In fact, maybe consider not seeing them at all, ever, and getting some new friends.

So yeah, its just like on TV. We even make out in the supply closets now and then.