It was a bitterly cold Friday night in February when I arrived at Rhode Island hospital for the second time in my life. I was about to begin my Emergency Department shadowing shift, but my emotions triggered flashbacks to the last time I had been there many months ago. It had been a Friday night in September when my best friend attempted suicide and was rushed to the emergency room by EMS. It was the worst night of her life, and mine. These memories haunted me as I looked into the eyes of every patient, parent, and child I encountered in the emergency room that icy Winter night. For all I knew, this could be the worst night of their lives, too.
As I entered the hospital, I was greeted by a high school volunteer. “Can you point me towards the emergency department?” I asked him. He motioned for me to come along and we walked quietly down long corridors. I broke the silence and asked him about his aspirations. “I want to become an ER doctor,” he declared. Little did he know, even though I was years ahead of him, we both had a winding road to become the doctors we so aspired to be.
The Anderson Emergency Center is the only Level I Trauma Center in southeastern New England. Translation: a Friday night in the emergency room is bound to be filled with chaos. At 4:58 PM, I stood in the line of the waiting room as I waited for the family assistant to escort me into the ER. Every seat in the enormous waiting room was filled with patients from all walks of life. One patient sitting in a wheelchair caught my eye. He was Caucasian, scruffy, and young, but most notably, his palm was squirting blood through layers of bandages. He looked intoxicated, agitated, and alone as he wheeled past me, looking for a towel, leaving behind a trail of blood. Meanwhile, a squealing toddler ran around the room, chased by her older sister as little red footprints appeared from the bloody puddle. I winced—this was only the waiting room.
The family assistant escorted me into the doctor’s area to meet my attending, who was anticipating an overnight shift. He walked with purpose and looked like he owned the place. In contrast, I was merely an undergraduate. No one quite knew what to do with me, nor I with myself. Should I smile or keep my head down? Should I ask questions or listen quietly? I felt selfish wandering around the emergency room merely to learn, unable to offer any assistance. Get used to it, I told myself.
Of the people I talked to, I was most fascinated by the fourth year medical student. To my surprise, he maintained vibrant aspirations, but with four more years of education under his belt. Modern medical education in the United States has become slightly more clinically focused in the past few decades, particularly in the third and fourth years of medical school, differing from European medical schools that combine undergraduate and medical education into six hands-on years. When I had shadowed at a Greek emergency department the summer before, medical students were performing checkups, taking histories, and participating in diagnosis. In contrast, this medical student did not appear to have any responsibilities. The thought of being 28-years-old and unable to treat patients made me sicker than the smells of bodily fluid, but his enthusiasm gave me hope that mine would not die out—at least in the next decade.
Throughout the two-hour shift, the attending physicians repeatedly apologized for the “boring night”. It made me wonder what any other night was like if a full waiting room and emergency department with every bed occupied by suffering patients was “boring.” The waiting room was filled with people experiencing homelessness and substance abuse. Tattooed men in orange jumpsuits were handcuffed to the walls. I walked past them, looking down and avoiding eye contact, feeling like an outsider.
Perhaps the most memorable patient I saw was a non-verbal African American teenager with Down Syndrome and congenital disabilities. I did not know if he could feel my stare on him, that my medical fascination could be perceived as judgment, so I looked toward the nurses instead. They loudly complained about his refusal to keep his IV in to treat his pneumonia. “The Hulk”, one nurse with fake eyelashes called him. They devised a plan to deliver his medication, and the poor boy looked terrified as four personnel held him down, telling him that it was for his own good, that if he went to the ICU they would stuff tubes down his throat. I stood in the corner, small, silent, reacting only when asked to react. When I came back to his room a few hours later, he was gone. I wondered where he went, and was on his side.
Many elderly patients filled the beds, taken from hospice, nearing the end of their lives. One overweight, elderly, Caucasian woman on kidney dialysis and suffering from pneumonia spent hours gasping for dear life with an oxygen mask on. At her side the entire time was a young male nurse who kept reminding her that she was “looking beautiful.” Why did she receive this level of care, whereas the boy with Down Syndrome did not?
Since my first ED experience, four years ago, I have spent hundreds of hours triaging patients at a trauma center in Providence, teaching a class on emergency medical systems at Brown University, conducting ED-based HIV testing programming in Kenya, and presenting emergency medicine research in New Orleans. The immediate shock and helplessness I had experienced during my first ED shift has turned into an ambition for treating patients with empathy and efficiency, while integrating public health into emergency care. While I still have a long way to go, my aspirations have only grown stronger and I am excited to continue to grow as a medical student.