Zack+F

= **Emergency Medicine** = My project was shadowing Dr. Ali S. Raja around in the Brigham and Women's Hospital for two days. He is the associate director of the trauma department. The first day we were in the Alpha room and the second day we were in the Bravo room.

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Goals:
The goal of my project was to learn more about the practice of medicine in emergency situations. I wanted to learn what makes emergency medicine different from other types of medicine. I was also interested in the use of modern tools, such as CT scans, and how they played a role in the emergency room.

Discoveries:
During my time at the hospital I saw many patients, of ranging problems and age. Unlike any other type of medical practice in emergency medicine the doctor cannot specialize like in other medical fields. The reason for this is that the doctor's need to be able to handle all types of situations.

A few of the patients I saw:

1. Male, 70’s, Hispanic – J tube for feeding through stomach, having stomach pains, checked him by palpating area, then CT scan. Meet and greet,

2. Male, 50’s, white- leukemia patient. Brought in ambulance hooked up to breathing apparatus and IV’s, low platelet count and rash on chest and side due to platelet count. Tube in mouth for breathing (intubation), IV’s for saline, and other meds. Six doctors and nurses working on him at once. His heart stopped for at least a couple of seconds (felt like a while), Heart monitor was flat lined. Doctors said heart stopped. Tense. Special nurses came in and did manual chest compressions to restart heart. Then put a sticky pad (metal) charged it and started up his heart. Ultrasound to see if blood was moving through body- pelvic and abdomen area. Lymph node in armpit really swollen. . They were taking blood samples and low platelets caused clotting problems so they were going to give him platelets later. Performed a second chest compression series before taken to ICU Prognosis not good – his body was fighting was to shut down, ready to die, harder to keep him alive. Docs in intensive care unit and family decided they would not restart if stopped again. Wife was there and brothers and kids arrived (7, 10, 14, + one more).

3. Male, 30’s, Asian/Black/multiracial – Tilapia bone stuck in esophagus. Felt uncomfortable but could swallow and drink x-ray showed small fish bone, called GI guys to come in to hospital. They put a camera on a scope into esophagus and found bone and took picture but it was above vocal chords and they did not think they could get it with their tools because it could fall in to trachea and make it worse. Called another specialist (ENT) in hospital and he used his tools to extract bone.

4. Female, 40’s, white, primary care doc, contacts (daily wear), left eye was infected and maybe a little in right eye. Completely red and eyelid was puffy but did not look very bad. No pus. Put fluorescent dye in eye and did not see pooling of dye so no scratch on cornea suspected. Really cool because when they turned off lights to see dye you could see her eye showing fluorescent. Prescribed eye drops.

In addition to this I learned a lot about the use of CT scans in hospitals and how they are overused many times simply because the risk of being sued is to great if they do not. One of the patients we saw had over ten CT scans in five years drastically increasing his risk of getting cancer. In the U.S. there is a 42% chance of getting cancer, after one CT scan there is a 42.1% chance.

Challenges:
The biggest challenge for me was probably trying to stay out of the way while observing. Another challenge was not freaking out or at least showing it when the mans heart stopped. Following up to that was not becoming emotional when I learned of his death that afternoon, it was particularly hard because I had spoken for a while with his brothers and learned about the family he was leaving behind.

Looking Back:
Looking back I would have gone into the hospital more prepared. When I went I had an idea of what I was looking for, but I was not as sure as I should have been. What made my project difficult was that the doctor was an Emergency Room doctor so I was not sure what I was going to see going into my shadowing experience. Having said that shadowing Dr. Raja was a great time and I am glad I decided to shadow him for my project.