The Tempest was one of the first plays I read while taking a crash course on all things Shakespearean in college. Prospero is a commander of nymphs, an engineer of enchantments and a conjurer of magic that is exiled onto a tropical island, using his talents for his own needs whether they be for vengeance or protection. Taking the opportunity to seek retribution upon a ship carrying those that banished him, Prospero, through the aid of his nymph, turns a placid sea into a roaring storm, capsizing and shipwrecking all on board. The pace of the emergency room often seems determined in the same capricious manner. One minute, the day’s moving at a snail’s pace with non-urgent patients meandering in with a sore throat or two and minor discomfort, taking time for granted, when without warning, we’re slammed with a wave of burst appendices, pulsatile aneurysms, and aches from every inch. The divide between calm and chaos can be a fickle one, gossamer at best, and while we’re all attempting to maneuver our own way through Prospero’s devices, it’s easy to underestimate the full force of tumultuous tides when you’re in the midst of tranquil waters.
Six weeks of psychiatry followed by six weeks of emergency medicine resulted in twelve weeks of two very different types of chaos. One was more of an inner turmoil while the other presented as an outward maelstrom, while both settings challenged me to maintain my own course. The ER served as our habitat for most of both rotations (three weeks of psychiatry consults), where we identified the patient, evaluated their relative level of distress, and tried to extract a thorough history of present illness. However, that’s where the paths diverged. In psychiatry, we were taught to chase the stories—any significant life changes occur recently?, what caused your relapse?, can you tell me about your childhood?— while emergency medicine coached us to chase the symptoms—where is the pain?, when did it start?, how would you characterize it?
Nevertheless, both fields advised us on becoming oriented to being disoriented. Some 20 years of lecture experience were swept by the wayside as I entered my first rotation, before I could even register how to transmute everything I learned in the classroom to the clinical setting. You stand helplessly as each and every day your comfort dissipates like ether from your clasp, doing the best with what you know and what you do not. The true wonders of medicine can’t be appreciated when it’s your first day as an MS3 against the gaggle of interns, fellows, and attendings who swiftly seem to know it all and do it better. Continue reading