Last shift as an ST1 – bittersweet to say the least

So for ACCS we have 6 monthly rotations for the first 2 years, and tomorrow I go for my last shift as part of my A&E rotation (yay, yes I made it to the end!) AND  it will be my last ever shift as a year 1 trainee (or ST1) – even more yay!

This year has been wonderful – I got to know the slightly different other side of the coin as an acute medicine doctor the first 6 months of this year, and got to see firsthand what happens when you refer a patient to the medical specialty: what they look for, how they assess them, what investigations do they do and what is there mindset – and I learnt there were things I could do while the patient was in ED as my patient, and I could tweak certain things and maybe request something that would help the acute medicine department deal with the patient and make an informed and safe decision about their medical care – and maybe stop them from being admitted in the first place! This last bit was especially a unique experience, trying to sort out a patient with the 4 hour time pressure, but sometimes you picked up a patient that usually would be referred to the medical specialty, but if you had the time in ED you could potentially start a treatment that may actually make them better before their 4 hours were up and you could end up sending them home rather than in-hospital – like for a second troponin or someone who is slightly tachycardia with a fever, treat them and re-evaluate, obviously if they still warrant it, get them admitted but if they improve and can continue treatment at home, then let them go into their own familiar surroundings (sometimes the best option for patients with dementia and other cognitive impairment) – and the it doesn’t go unappreciated by the medical team!

The next 6 months were truly wonderful – learning experience from the get go – and since emergency medicine is my chose poison, my specialty of interest, I really was looking forward to it – and it did not disappoint. I learnt so many new things, and not just about the medical bit of it, but about myself as well. I gained confidence. I passed an exam (again, yay!). I realised I was interested in paediatrics, with a possible PEM (paediatric emergency medicine) fellowship consideration seriously for the future). I realised it wasn’t JUST about the resus patients, the cardiac events and the rest pains and the low-GCS and the stabbed-in-the-groin and the 3 passenger trauma call  – those were the interesting and the adrenaline pumping stuff you think of when you think emergency medicine. But I also realised that on a day to day basis you may not even see any of those heart-pumping sort of cases, and may have to deal with accidental overdoses and dental pains (!!!) and minor injuries (oh how I loved the minor injuries – really loved learning there!) and the beautifully vague C?C or ‘Collapse query cause’ and an amazing amount of geriatric and elderly care cases. And I realised I had chosen the right field. Because you don’t just treat the stuff of legend – crack open a chest or put a tube into the chest or restore alignment of a broken or dislocated bone, but you also end up (mostly) sorting out the more mundane cases and they teach you patience and empathy and make you also realise that these cases are also equally important: passing a catheter may be considered a legendary feat by the patient who comes in with 15 hours of urinary retention, or the wrist brace you put on an elderly patient with a sprain may make a world of difference to an elderly patient who has been unable to sleep due to the pain. It is the sorting of these cases which some may consider to be ‘boring’ or ‘brander’ or ‘not exciting’ that is truly the bread and butter of the ED physician.

And now I stand at the cusp of transitioning from year 1 to year 2 – going onwards to a 6 month rotation in aesthetics followed by ITU for 6 months. Am I excited? Yes. Am I nervous? You bet! Why excited, you ask? because: new things to learn and do that I have never known/done before. Why nervous? Because…exactly the same reason! But I am certainly looking forward to airway skills and critical care assessment, and gaining more confidence by adding to my skills – I hope its not too steep of a learning curve! Onwards and upwards, eh?

(Also – no weekends or nights for the first three months in aesthetics, and Friday half day –  somebody pinch me! I might just die of excitement at the prospect of that routine after the A&E rota! So yeah, joy!)

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