Hello from the peds ER! I'm doing my pediatric emergency month right now, and I'm really enjoying myself. I thought I'd hate it because kids aren't my thing, but surprisingly I've found it a joy to work with them. They can be really cute and I'm finding that I can build a good rapport with them and their parents...well, most of the time anyway. Such a change from my student days where I was distancing myself from babies at arms' length! And the people I'm working with (attendings, most students, the nurses) are great fun to be around.

The only thing I don't like is doing procedures (including bloods) on them because obviously they don't like it and kick and scream as soon as they see you coming, and it's hard for parents to watch. But c'est la vie, has to be done. The last day I got an IV in a 5 month old on my first try and nearly whooped with joy. I've done a few laceration repairs (always with shaky hands, those kids are so jumpy) and a couple foreign body removals (ie. beads stuck up noses).

Another thing that's really difficult is when something bad happens. Today, a child who was seen yesterday (on my day off) and admitted to the hospital took a turn for the worse and passed away. It really upset the staff because the child came into the ED communicating well and fairly stable on admission, but started deteriorating soon after. As always, there is reflection and discussion about appropriate management, as well as quite a few tears and empathy for those poor parents. It put a damper on things but then you have to focus on the kids currently in the ED and work resumes again. I've worked in MICU before where things are sad and serious, but there's just a lot more gravity when a child is affected.

Anyway, after I wrote last, we had 2 weeks of ER orientation which were great - I finally understand how to read ECGs better, a smidge about how to read ultrasounds (I still need a lot of practice) and refreshed some facts in the far depths of my memory. I'm always going to have to be studying, but still trying to settle in a bit which is a) very expensive and b) very time-consuming! I must have contributed to half of Bed Bath and Beyond's profit share this month!

The last two weeks of July we did shifts in the adult ED and a couple shifts in the peds ED. I was hoping it'd be smooth transition, but I think all of us got caught trying to get used to the system. The first week was frustrating, asking everyone how to order things on the computer which really slowed us down, forgetting to ask things in the history and having to go back to ask, forgetting answers to questions I knew way back when while getting pimped (lightly, there's no heavy pimping that goes on here that I've seen) but should definitely know (I totally forgot about anion gap / electrolyte stuff in hyperglycemia), etc. But I think we've gotten into the groove of things now and developed some rapport with the people we work with. 

I like our peds ED because you see a greater volume of  "easier" patients so I've gotten practice with getting histories quickly and doing examinations quickly, as well as multi-tasking because I'm also the most senior person there in the mornings so I take all the students' presentations and my work quadruples in like 20 minutes if it's busy. The peds ED can get really crowded and busy too, which is a useful experience to have when people are shouting all over the place to hear each other and everyone's hurrying everywhere and things are falling onto the floor and babies are screaming, etc. 

The only thing I wish we had more of us a little direct supervision. Not that I want hand holding, but sometimes...you're seriously thrown into things without a) having done it before or b) knowing the exact specifics of how to do it and c) without someone watching you. Talk about knowing some theory, trying to apply it practically and praying to God you don't F__ up. I can understand how it's useful to be thrown into it, and the situations I've dealt with aren't that serious, but talk about adrenaline pumping. And not only that, sometimes I find myself teaching / supervising people doing things when I haven't even done it myself. You seriously take the bull by the horns, grit your teeth and just do it. Everyone is very nice and offers help, but it comes more in verbal advice rather than direct supervision. This is how it works in a busy system that does not have as much staffing as other places might...and you know, it has worked for now and made me a lot more confident. But I'll keep praying!