The End

As the automated doors swooshed open I walked out into the warm summer's night.

I looked down at my watch... it read 01:28am

I looked forwards... remembering words from a 'long time ago'*:

"Don't look back...before you go.
Eyes forward.
Choices to make...dreams to realise.
Don't look back...before you go.
Know the truth; learn to let go

It will be a hard life;
One without reward, without remorse, without regret.
A path will be placed before you, the choice is yours alone.
Do what you think you cannot do. It will be a hard life,
But you will find out, who you are.."

I slid the Litmann stethescope over my head and shoved it into my pocket, dangling out like a schoolboy's handerkerchief. I looked up at the dark summer sky and breathed it in.

It was over. Internship. And what a way to finish.

[1400 earlier that day]

It began like any other day. Rocking up to cubes to put in my time sheet (seeing as I was going to be on holidays when they were due next week) so I got paid. licking on the computer to check how many patients were queued up and which other doctors I'd be working with this shift.

Picked up my first one, a darling little old lady with "knee pain"... opened the door and started my usualy spiel, "Hi Mrs P, my name's J and I'm one of the doctors... do you want to tell me what's been happening?"

[1800 that same day]
There was no more room in the inn as we churned thru the patients and the day staff tried to hand over their remaining patients to those on night shift (ie me). I tired to discharge a patient with chronic cellulitis only to have my enthusiasitc registrar diagnose 'erythema multiforme' (she'd only seen it once in her entire life!) and thus relegating the patient to the medical registrar instead of home.
Mrs P sat in her room, with her faithful husband by her side, having just returned from the CT scanner... her bones were osteopenic and almost no bone density whatsoever. Her husband had been caring for her day after day since she lost her sight and I looked at their relationship feelign envious... their love apparent... not in displays of affection.. but in the daily sacrifices he made for me to care for her.

[2100 that evening]
A rather hungry intern named J started to sway from side to side from low blood sugar as the waiting room list exploded with patients who really shoudl know better. A young girl (20) hobbled in with her mother complaining of back pain after she had got a friend to 'crack' her back and [gasp] developed back pain shortly thereafter... like duh!

It was at this point all hell broke loose.

I walked out to the acute area to see a sea of stretchers with young men in hard collars being shoved into the ED. However as there were no beds free (due to a few infarcting oldies) they were just dumped in the walkway of the ED. I found out of my registrar that there had been a big MVA** and you could see the excitement in her eyes. Next minute she was gone, off to play 'trauma' and see some action and so I duly found myself abandoned with a department full of cubicle patients requiring registrar review. Truth be told their was an overseas doctor on as well, but he committed a cardinal sin and started sifting through the files to pick up simple finger fractures and lacerations... leaving me to pick up the miscarriages, the bizarre neurological symptoms and the meningitis patient.

It reminded me of an episdoe of ER I saw last year. All the senior doctors are out farwelling Dr Carter and the interns are left to run ED. A balcony collapses and the interns are forced to assume responsibility and it all makes for a very nice dramatic TV show. However in real life it just drove me nuts. I had cranky patients wanting to be seen in the waiting room. I had cranky patients in the rooms wanting to go home. I had cranky nurses wanting to know "what's happening" with each patient.

I just kept plodding along... reminding myself that if I lost it, I would be of no help to anyone.

"Just take one patient at a time J... one at a time" It was reminiscent of that firstovertime shift from hell in Whoop Whoop. And yet I was more confident.

And so I kept working them up, sending off bloods. Charting analgesia for people in the waiting room so as to at least "do no harm".

Eventually at 1am, the 2 registrars and consultant emerged from the chaos of the acute area dn came around to see how I was faring.

Exasperated I began my final handover "Mrs P is a 77 yr old female who was brought in by her husband after she sustained a twisting injury to her left knee. She had a CT of the left knee and was assessed by ortho as having no fracture and is for med reg review for analgesia and mobility seeing as she is blind and can't go home with her husband whilst she is immobile"

Why med reg? Why wont ortho accept? Why didn't you tell them about the ED's 'one referral policy'? How's she going to manage at home if we just keep her overnight?

Mrs P got admitted I think... the last patient I saw as an intern.

To be honest... I was over it. I made the last few phone calls, handed over the patient who needed a lumbar puncture and walked out the door for the last time as an intern. I had survived.

This week I'm on annual leave before starting back as a resident. Lats night i met up with almost all of my med school friends at our local Thai restaurant. The last time we had gathered there all together was after we finsihed med school. How fitting then that our reunion of sorts occured in the same place after our internships were finishing. Somehow we've all made it through (which given the high suicide rate of JMO's is a great feat to be thankful for) and none of us are drug addicts (or at least admitting to it).

To all of you readers out there who've read my blog/called me up and left messages of empathy, frustration, encouragement and urged me to persevere thru this... thankyou! No man is an island... and particularly fellow brother and sister interns... you guys rock! Congratulations!

It's time for "The Intern Experiment" to end. Don't worry I will now start writing the resident equivalent (http://theresidentexperiment.blogspot.com)... but as my internship has now come to a close... so must this blog. A closed chapter now to look back on and laugh, cry and smile at the biggest year of my life to date.

And so I want to finish this blog... with some quotes from ER... only because then encapture things that I cannot sum up any better:

When you do everything you can, sometimes more than you thought you could, you've got to walk away knowing you fought the good fight. You fought the good fight, Lucy. And tomorrow you'll fight another one.

You are wedges. The wedge is the most primitive tool known to man. That is you. You think you know what you're doing, believe me, you don't. Breakfast with your Senior Surgical Resident Dr. Benton will begin in 15 minutes. Dr. Benton is an intern's worst nightmare. He's smarter than you, he never eats, he never sleeps and he reads every medical journal no matter how obscure. He is the Antichrist. Beelzebub. Lucifer. A devourer of wedges. You will go to sleep at night wishing plague and pestilence on his unborn children and you will wake up every morning praying for his approval. You won't get it. Welcome to hell, ladies and gentlemen.

Patient: Are you married?
Doctor: No, I'm a doctor.

Patient: Oh, God, I see a light!
Doctor: You're not dying. It's just your ankle

Doctor 1: They can make your life easier or they can make it miserable. Whatever you did, I suggest you apologize immediately.
Doctor 2: I didn't do anything.
Doctor 1: Apologize anyway.

Most interns send their samples without knowing what happens once they're there. Let's pretend we're a urine sample and find out.

I'm beginning to think that "ER" stands for "everyone's retarded".

Rule #1, feed the nurses. It makes the job 50% easier

See, there's two kinds of doctors. The kind that gets rid of their feelings. And the kind that keeps them. If you're going to keep your feelings, you're going to get sick from time to time. That's just how it works. That's part of it. Helping people is more important than how we feel. Hell, I've been doing this eight years, and I still get sick

You set the tone, Carter!

* Star Wars Episode I The Phantom Menace Trailers ("One Love" and ""One Destiny")
** motor vehicle accident for my non-ER-watching friends

Full circle

Happy New Year and happy birthday to my blog.

After 1 year and 127 posts, some of you crazy kids are still bothering to read my ramblings and so I guess I'll just keep on typing away.

It is now the dawn of a new year and the sun is shining brightly through my window.

"What a big year it has been... too much stuff has gone on to fit it all in this post... but let's just say I'm glad its over! Let's hope I'm not working ED next NYE!"

- The Intern Experiment Jan 1st 2006

Seems I was very keen to leave 2005 behind last year. If only I had known what 2006 would be like, perhaps I would have been less hasty to rush headlong into what this past year entailed. And so I'll repeat the same things I did last year... I'm glad 2006 is over. It's been a year of beginnings and endings... of intense joy and pain and a new depth to life that I didn't know existed.

I spent NYE this year at a friend's house. He graciously invited me over to join his dinner party where we ate good food, played some fun games and ushered in the new year watching fireworks from his rooftop and on television. It was just what I needed.

The fireworks pierced the black sky showering their light into the darkness. And I felt like the angst of the past was being washed away to make room for a New year. The cracking of the gunpowder... breaking the silence in my life.

It's time for a new beginning. Time to shed the skin of last year and walk boldly into the opportunities of 2007. So a Happy New Year (xing nian kwai lei) to all you blog readers out there. May your 2007 be full of joy and fond memories!

"Until next time, stay classy Sand Diego"

An unorthodox festivity

The Silent Night was broken by the dawn on a cold and rainy morning. I dragged myself out of my warm bed and staggered to the bathroom to shower. Welcome to Christmas 2006.

A long distance phone call was made to the family to wish them festivities and say goodbye to my sister departing overseas yet again. The sound of the family enjoying themselves only made the distance seem further than it really was. I kinda wished that somehow they would show up on my doorstep to suprise me, but knew this would not happen.

The streets were devoid of the usual morning ebb and flow, as people spent treasured moments insdie with their families. I walked in eerily silence to the bustop and caught a ride into the city. Against the grey city outline I sought out the sandstone cathedral dwarfed by the surrounding skyscrapers.

With each song, the choir turned well loved meoldies into muscial poetry. The small gathering were reminded both in song and word of the hope that Christmas brings to all of us in Jesus. It was nice to just be alone for once and be anonymous. To sit and drink it all in. To thank my Lord for this day.

When I got home, I started to get ready to cook my traditional roast dinner when my phone rang. It was my intern buddies from other hospitals, fellow Christmas orphans in need of company on this Christmas day. And so my well planned out dinner was shelved and I found myself in the city eating Yum Cha and celebrating with good friends. It was a far cry from my desired turkey... but far more enjoyable than eating alone.

Finally the clock ticked over to 2pm and I found myself in the ED on Christmas. It was not too busy, the nurses were decked out in tacky $2 Santa hats and there was so much junk food we could have had an infarct ourselves. Some bored nurses started playing Christmas CDs over the ED intercom just to annoy everyone and one fo the specialists donated 2 bottles of champagne for us to crack open in celebration.

The atmosphere was jovial, the registrars were casual and it was great. We even had our own Rudolph the Red Nosed Drunk*

One lady came in with a head injury from a flying shoe (that her adult daughter had thrown at her) One girl came in with a black eye (that her drunk grandfather had inflicted on her) One guy came in vomitting blood (after he'd binged on alcohol for a month).

Amidst the celebrations, the awfulness of life sat side by side with the joys of life. Whilst some partied, others suffered. It was a far cry from my family based traditional Christmas. But it was a Christmas to remember.

* A rounded German man who was a Nazi sniper (apparently) and now spends his life getting drunk and wanting to commit suicide and frequently fronting up to ED.

The Importance of Christmas

I must admit I'm a Christmas addict.

Being raised by a British mother, I was indoctrinated early into all things traditional about the festive season.

Our family would never dream of anything less than a roasted turkey for lunch on Christmas Day with all the trimmings and church in the morning.

Christmas Carols MUST be watched the evening before Christmas and lame jokes about leaving grass out for reindeer must be laughed at every time wihtout fail.

And I luv every bit of it!

But it's not the trimmings that make Christmas special.

I couldn't care much for the presents (although they are quite nice and I'm happy to have them)

And although I luv them dearly it's not about family either.

It's all about the 'reason for the season' (so they say)

Each Christmas I am so amazed and excited to think about how God limited himself and humbled himself enough to become a human.

To eat and breath with us. To share our pain and toil. To share our joys and passions. To wrench us from the power of death.

I cannot help but well up with pride and emotion as I hear the Christmas message sound forth each year in carols.

Their words so articulately enshrine the exciting news that happened 2000 years ago. That in a backwater town, out the back of a pub, was born the chosen one who woudl die in my place to break death itself and bring us into freedom.
"Born to raise the sons of earth,
Born to give them second birth.

Adam's likeness now efface,

Stamp thine image in it's place,

Second Adam from above,
Reinstate us in thy love"

This day is so important because it breaks the passage of time in two. The entire history of the world hinges on it. The dawn of a 'new and glorious morn' arrives. As I remember the plan of the ages fulfilled that lonely night, I look forward to the final chapter in which:
"Once again the scene was chang'd New earth there seem'd to be, I saw the Holy City Beside the tideless sea. The light of God was on its streets The gates were open wide And all who would might enter And no one was denied. No need of moon or stars by night, Or sun to shine by day, It was the new Jerusalem That would not pass away "Jerusalem! Jerusalem Sing for the night is o'er Hosanna in the highest Hosanna for evermore!"

Amen.

Christmas

Last weekend I had an early Christmas.

Due to the fact I'm stuck in ED on Christmas Day, I decided to string together some days off and go home to spend Christmas with my family a week early.

As I flew home I gazed out into the distance over the dry dusty countryside. It amazed me just how barren and lifeless the land had become. Perhaps symbolic of what was to await me?

As the plane touched down I saw a familiar shape waving intently at the plane.

It was Dad.

As I got off the plane, I tilted my head down; half embaressed by the display he was putting on and half trying to avoid facing the reality of a man I once knew.

Finally I looked up... and as I looked up I saw a man that shocked me. A man devoid of the warm beard he once sported, the beard that had defined his care and yet his authority. The beard that had not been removed since before his marriage. It was now gone and the face I saw beneath looked too familar. Too much like mine.

The next few days showed just how much his degeneration had come. Familiar names meant nothing to him anymore. Phrases were less constructed and more bizarre. Days were spent picking up the leaves and sticks in the yard (purpose? we do not know but dare not ask).

The man who once controlled hundreds of millions of dollars of roadworks could no longer control his bladder. Days once spent in government meetings were now spent in front of a television waiting for the afternoon gameshows.

His new friends were now the strangers he met on the street. His old friends were now the ones he didn't know.

And yet as we exchanged gifts, it was as though time had forgotten the last year and he was the man I once knew. The familiar Christmas carols and rituals brought back memories of past festivities shared with this man. The out of tune singing, the warm summer nights, the home cooked roast.

Last Christmas I called this man "Dad", one year later he mistakenly called me his "Dad".

As I flew back to Sydney, I was confused. Was I leaving home? Or was I coming home?

As I hugged my mother and felt her tears, I knew that the dream I once remembered of home had gone. The warm past was gone and the cold future awaits.

Merry Christmas to all you blog readers... please treasure each Christmas day you have with your loved ones. You don't know how many you'll have.

The good, the bad and the ugly...

The Good:
Getting a free Christmas lunch at work with hot chicken and salad followed by yummy mud cake. The bosses decided to splash out and suprise us all which was very nice of them and meant I actually got fed for once in ED.

The Bad:
Finding out I had a patient call up over the weekend and complain that I sent her home when she couldn't walk. To be honest, she was treated very quickly because we had a lot of other people waiting. And I DID make sure she had crutchs and asked the nurses to make sure she was ok befroe she left. Anyway, yeah in an ideal world I shoudl have done better but honestly, we had no registrar to cover us so we were pretty snowed under... just cranky that after trying to help these people they still complain... as my Mum would say... "If you're gonna die... go die quietly in the corner and don't make a mess on my nice clean floor"

The Ugly:

My face. Mum and Dad got me an electric razor for Christmas and so after years of using the cream and razor it's time to go electric. However according to some random site I Googled about tips for achieving a smooth shave it takes 1 month for the epithelial scar tissue to change (when you blade it you scar the underlying skin each time whereas with electric you dont) and during this time apparently one's face is supposed to undergo some weird skin remodelling. And so it's kinda uncomfortable and rough, but hopefull in a few weeks time my face will have evolved into a more electric-friendly protoplasm to deal with.

The future...

Well the next 12 months of my life have now been set in stone and my social life will now have to accomodate the ordinances of the Zoo.

So what lies in store for Dr J next year? Fun filled medicine in the wards he once trod and loved?

Not really.

Term 1 - ED

That's right kids Dr J your favourite fun loving doc is back for round 2 in the ER. Usually people like to take a break from the banality of chest pain and PV bleeders but not J. He's overdosing on the excitement in the ED just becasue he can (well, actually is forced to). So whilst he graduates into being a 'resident', a flood of eager but paralysingly slow interns will be forging their way through the waiting room list and begging him for advice on stuff he himself has no idea about.

Term 2 - Relief

Contrary to the sound of the name, this term is NOT a relief...it is usually an excuse for JMO management to banish you back to ED under the excuse of "to help out the new overseas doctors" People generally take time off on terms they dont like.. and so you end up filling in for jobs that no one wants and do a whole lot of scut work.

Term 3 - Paediatrics

Time to do something I enjoy for once! Yes, that's right about 10 years ago (man I'm old) I decided I wanted to be a paediatrician and help sick kiddies. 10 years later it's still quite an appealing job. No grumpy old people and their non-English speaking families; just a whole lot of litigous over anxious parents with snotty kids. Thankfully the cafe in paediatric section makes up for the bad food elsewhere in the hospital.

Term 4 - Geriatric Rehab

They're incontinent of urine and faeces, they can't tell you what's wrong and no they're not babies.
Most people become suicidal when receiving a geriatric term. 10 weeks of crumbly old people who never get better. I was advised strongly by my GP trainers to do a geri's term to help me in the future. I despised working the geri overtimes though this year and so very cleverly (gold star to me) snuck into a geris rehab term where most of their acute medical problems are sorted out and they are just getting some 'body-building" (read: physiotherapy) prior to going home so they can have another fall and die within 12 months*

Term 5 - ICU

The one thing I have never done in med school (thanks to some clever wagging) was Intensive care. Thsoe people with bazillions of tubes stuck into every orifice just didn't appeal to me. No patient's awake to talk to, no happy discharges home and no happy relatives. And yet somehow I got lumped with a whole term of this with 12 hour/day 7 day/week work (on a rotating basis). I just dread the thought of advanced physiology/pharmacology. Thankfully I've got 2 weeks of annual leave then to break the suicidality I might be experiencing.

And so this is what 2007 will look like for me. Not much fun by the sounds of it.

But along with this comes a sad realisation. I have no more surgical terms. Due to intern requirements and SRMO's BST needs, I will never again don the scrubs. I will never scrub in to assist again. My last operation was my total colectomy at 3am in the morning. I'm kinda sad about that. I, who was once a hater of all things surgical am now lamenting the oppurtunity to wear those blues.

Soon it'll be time to end the "Intern Experiment" and start the "Resident Experiment"...

* statistically once you break that femoral neck you generally have less than 12 months to live.

Restless J syndrome

Causes: Seeing off too many good friends at the airport, disruptive shift-work, lack of friends around during days off, family illness, lack of girlfriend, surmounting end of year bills, stupid hospital admin, propsect of 'another' term in ED.

History: Patient usually spends time at work wishing they were not and when not at work bored out of their brain and wishing they were anywhere else. Gets frustrated with life for no particular reason. Intolerance for minor issues and excessive somnolence. Poor dietary intake of take away.

Tests: Seretonin level, intolerance severity index, TFTs, EEG.

Treatment: Gold standard therapy is with multidrug therapy of holidayavir combined with peoplepril. Delays in initiating treatment can lead to the morbid complication of 'burnout' which can only be rectified by goinghomestatin.

Each week I hear of yet another friend taking off overseas/interstate on holidays and I just watch out the window of my house and watch the planes fly overhead wishing I was going too. Everyone else is getting exctied about the holiday season and I am stuck in ED on Christmas Day with no family or friends.

It's just hard to get excited about life when all it consists of is work and sleep. Work itself is actually not that bad at the moment. But somehow it's just not satisfying.

You know you're a doctor when...

You believe that all bleeding stops ... eventually.
You find humor in other people's stupidity.
You believe that 90% of people are a poor excuse for protoplasm.
Discussing dismemberment over a gourmet meal seems perfectly normal to you.
Your idea of fine dining is anywhere you can sit down to eat.
You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants.
You plan your dinner break whilst lavaging an overdose patient.
Your diet consists of food that has gone through more processing than most computers.
You believe chocolate is a food group.
You refer to vegetables and are not talking about a food group.
You have the bladder capacity of five people.
Your idea of a good time is a cardiac arrest at shift change.
You believe in aerial spraying of Prozac.
You disbelieve 90% of what you are told and 75% of what you see.
You have your weekends off planned for a year in advance.
You encourage an obnoxious patient to sign a self discharge form so you don't have to deal with them any longer.
You believe that "shallow gene pool" should be a recognized diagnosis.
You believe that the government should require a permit to reproduce.
You believe that unspeakable evils will befall anyone who utters the phrase "Wow, it's really quiet isn't it".
You threaten to strangle anyone who even starts to say the "q" word when it is even remotely calm.
You say to yourself "great veins" when looking at complete strangers at the grocery store.
You have ever wanted to hold a seminar entitled "Suicide ... Doing It Right".
You feel that most suicide attempts should be given a free subscription to "Guns and Ammo" magazine.
You have ever had a patient look you straight in the eye and say "I have no idea how that got stuck in there".
You have ever had to leave a patient's room before you begin to laugh uncontrollably.
Your favorite hallucinogen is exhaustion.
You think that caffeine should be available in IV form.
You believe the waiting room should be equipped with a Valium fountain.
You play poker by betting ectopics on ECGs.
You want the lab to perform a "dropkick" screen.
You have been exposed to so many X-rays that you consider radiation a form of birth control.
You believe that waiting room time should be proportional to length of time from symptom onset.
Your most common assessment question is "what changed tonight to make it an emergency after 6 hours / days / weeks / months / years)?".
You have ever had a patient control his seizures when offered some food.
Your idea of gambling is an blood alcohol level pool instead of a football pool.
You shock someone with an unrecognizable rhythm ... until you get one you DO recognize.
You believe a book entitled 'Suicide: Getting it Right the First Time' will be your next project.
You call subcutaneous emphysema "Rice Bubbles".
Your immune system is so well developed that it has been known to attack squirrels in the backyard.

(adapted form a source for nurses but I think it's more applicable to doctors in ED in Australia)

Introductions

Well I feel a bit bad for not introducing you avid readers to the family of people who work in Emergency. They're an eclectic bunch with their own idiosyncrasies... but they're not too bad.

1. The triage nurse
Job description: to ask people what's wrong with them and make sure that the people with gunshot wounds or heart attacks get seen before the people with a sore toenail that's been there for 5 months.
Personality type: usually very task orientated and abrupt, knows the 'frequent flyers' to ED and warns you of them, often provide valuable advice about the patient's social situation before you see them (such as "the guy who dropped her off was carrying a great big knife" - always helpful to know!)

2. Ambulance officer
Job description: They are the delivery boys of our pizza shop. Except instead of getting rid of our products, they bring us more work. Thanks! Supposedly have some kind of training in first aid and some basic medical stuff, they love to run around with their sirens blazing and picking up the old ladies who 'had a bit of tummy pain'
Personality type: although they see a lot of action, they love to laze around after they've dropped off their customer and flirt with triage nurses or admin staff. Nige-phobes in that they often travel in packs and all arrive at the ED at once so they can hang out together, but having the undesired effect of making the doctors inside panic when they see 4 ambulances pulling up at once.

3. Comms clerk
Job description: To do all the dirty work of phoning up and getting a hold of extremely difficult people to contact. Whereas on the ward you would spend hours wasting time chasing down surgical registrars who refused to answer their page, these lovely people get them waiting on the line for you then announce over the intercom "Dr J to the bridge, surgical registrar on the line" thereby saving you the pain of having to find them.
Personality type: Anyone who can hunt down a surgical registrar must have a fair bit of tenacity and perseverance. They are generally very friendly for people who probably cop abuse all day from disgruntled doctors and are much more efficient than the switchboard.

4. The radiographers
Job description: To Xray anything that hurts in the Emergency Department because we are too precious to go across the hallway to the 'real' radiology departmant. They are a highly organised SWAT team of imaging and are veiled behind their magic lead-coated curtain.
Personality type: Reclusive. They rarely venutre out except to grab the next patient and then hide back in their little room devoid of sunlight or human touch. They make Quasimodo of Notre Dame look like a social butterfly.

5. The ED nurses
Job description: Never (I repeat NEVER) to be confused with their less evolved cousins the 'ward nurses', the ED nurses pride themselves on getting to wear blue scrubs like the doctors and being able to [gasp] insert IV cannulaes and take blood. Their job is to constantly hassle the doctors to find out what the management plan is so that they can enter their 'times' into the data collection system to make the State government look good for the upcoming election. They are also prone to the vice of the ward nurses known as the 'tea-break' which means that although you are not allowed to even relieve yourself, they may take all day to administer those medications if it even looks like interfering with their mandatory union-provided tea-break.
Personality type: generally less amoebic in intellect than the wards, they have let this confidence brew into disdain and can be more aggressive with interns who they don't trust* however provide a refreshing change because most of them 'want' to be in ED.

6. ED consultants/staff specialists
Job description: to run the department and direct medical care whilst keeping an eye on those dodgy young junior medical officers to prevent any mishaps and bad media coverage for the hospital.
Personality type: anyone who chooses to work shift work beyond the age of 35 is generally highly driven and does not want to 'settle' into the mundane life of general medicine. Often like to balance their career with extreme sports or vehicles and believe that every other department in the hospital revolves around them. Often willing to abuse ward registrars for not seeing the ED patients and will gloat about it afterwards.

7. ED registrars
Job descritption: To help run the ED whilst studying intensely every aspect of medicine so they can become like the above-mentioned consultants. Also run the entire ED on their own between the hours of 11pm and 8am when they have cortisol induced hypotension which they relieve by carrying around a large bottle of caffeine such as a 2L bottle of Coke Zero or the like.
Personality type: Not quite a boss and no longer a scut-monkey** they still have some humane aspects but enough cynicism to help them get through each day. Usually complaining non-stop about how overworked they are (which is true) they spend their spare time either doing extreme sports again or writing letters to our boss asking for more fellow registrars to be employed to share the load.

8. ED Interns and Residents
Job description: To see patients in the ED and then not really think too much about them because they have to present them to the boss anyway. Pretend to know something whilst really knowing they know less than they should. Try not to kill too many people*** and not pick up any gomers (old people) within the last hour before they leave. Have a glazed look after night shift which indicates their apathy and incompetence by the end.
Personality type: Over achievers who start to panic when they realise they may be out of their depth sometimes. Often seek outlets for their crazy wokring life, like drugs or chatting up allied health staff in early hours of the night shift.

And so here we have our wonderful world where we all run around in a noisy fast paced frenzy. This last week I have been doing night shift was has been a blast. Eating junk food with nice nurses (including a girl I used to know in high school) and having 'intern teaching' from a bleary eyed registrar at 5am. I've seen all sorts of diverse things such as a newly-diagnosed-brain tumour, a completely dislocated wrist with no sensation or pulse, a security guard who was beat up, chronic 'period pain', hyperventilation syndrome, someone with a lack-of-direction in his life (very urgent thing at 5am in the morning!) and am never ceasing to be amazed at what things people classify as an 'Emergency' in the wee hours of the night.

Can't you people read the sign? It says E-M-E-R-G-E-N-C-Y!


* one notable example was when I was told at handover round that a patient was to be admitted to the psychiatric ward once a bed was available. I was pestered non-stop by a senior ED nurse because it wasn't documented in the notes. I looked through the notes and found a clear entry from the ED consultant saying "Patient discussed with psychiatry registrar and for admission under the psychiatrists" Apparently that was not good enough and I was forced to 'reaffirm' this directive with a rather irate psych registrar at 5am in the morning.
** "Scut-monkey" is a term used to describe me and other junior med officers cos we end up doing all the crappy jobs that other doctors dont wanna do cos we are the bottom of the food chain.
***One shift started with a new registrar introducing himself to me and saying "I don't care how many of these patients you kill, as long as you don't link them to me in any way" - I hope he was kidding?