A Day in the Life of an Emergency Medicine Resident

5:50 am	Alarm goes off. I hit the snooze button and when it goes off again, I know it's time to peel my face off the pillow and get going.
7:03	Arrive at work and go put my stuff away. I pull out my bag of snacks (it gives me energy and motivation) and head to find a computer to set up shop. I sign in to our system, usually start by picking up the first two that are waiting to be seen. Before I go see them, I look through their electronic medical record to see how often they frequent the ED, what their medical problems are, etc. The first patient is an elderly gentleman with a ton of medical problems and abdominal pain. I go to see him but I'm pretty sure he's getting a CT scan (older people with abdominal pain=bad). The other pt is a young person with a headache and history of migraines. See them, place some orders in the computer and move on.
8:00	Charge nurse walks over and informs our team that we'll be getting a young male cardiac arrest. We gown up. The second year resident is airway, the third year resident usually runs the code and the intern gets the code central line. The patient arrives, he's intubated by EMS and we have no history. EMS was called by a friend who stated that he just passed out while watching TV. He is in PEA. We go through our ACLS protocols and were never successful in getting a pulse. This patient didn't make it and now the team leader must go break the news to his family. Was it drug overdose, a deadly arrhythmia from WPW, poisoning? We will never know. It's very unfortunate but we have to move on.
9:05	One of the day nurses asks for a resident to go and see the 84-year-old lady in bed one who's heart rate is 30. I walk over to the bedside thinking about the scenarios. Stable vs unstable. What will I do first? Does she have a blood pressure? It's a short walk so I get there and she's sitting up in bed talking to her daughter. Her blood pressure is normal and she tells me she was feeling fine but her PCP sent her here because her heart was "beating too slow." I grab her EKG and she has a complete heart block but she's been completely asymptomatic with it. The nurses have pacer pads on the patient before I even get a chance to ask. I'm glad she's stable and I can leave her bedside to call cardiology so that they can take her upstairs and place a pacemaker in her while she's stable. Several more patients are seen throughout the day with the same basic premise in mind going in to see them. Are they stable or unstable? What are the life-threatening conditions that this person may have that are consistent with their complaints? What tests or studies that will help me determine the problem? Do I need any consultants immediately? After seeing several patients with complaints varying from vaginal bleeding to a newborn with a fever, to a finger laceration and finally you have made it to the end of your shift.
3:00 pm	It's that time and the relief is starting to trickle in which makes me very happy. At Baystate, the ED is always packed with patients and it's always busy. At the end of your 8 hours, you are quite ready for sign out. You finish wrapping up your patients. Getting them admitted or discharged and finishing the paperwork for the ones that you need to sign out.
3:30	Sign out for team A is announced overhead. Everyone gathers and we talk about our patients that are left.
4:15	The paperwork is finished and it's time to get home. It's time to go make some dinner for my husband and walk the dog...maybe go to the gym (only on a very ambitious day). It's hard to describe one day because everyday is very different. As long as you come equipped with a great attitude and a stethoscope, everyday will be exciting with many opportunities to learn and develop your clinical skills.