RIH ED Shadowing

For my shadowing experience, I visited the Rhode Island Hospital Emergency Department Saturday November 7th. There are countless doctors who work there on any given shift, but I stayed mainly in "trauma alley" where the most critical patients are cared for, nearest to the ambulance bay. As it was a Saturday, an overwhelming majority of he patients we saw were intoxicated, complicating their diagnoses and care and often causing the injury or illness that led them to the ED. More than one patient required mechanical restraint either by security or soft-restraints and one patient was given Haloperidol to chemically restrain him and facilitate his treatment. There were numerous assault victims, many of whom arrived around 2 am, when most of the bars downtown close.

This was by no means an unusual situation. I had the opportunity to ask one of the ED residents about what role alcohol plays in patient care and he responded that it causes and complicates far too many injuries whether through drunk driving, poor judgment, or extreme intoxication. During my time there we saw a pair of Rhode Island State Troopers arrive with a patient implicated in a car accident. These officers are often at the ED, but are not privy to a patient's medical information. Dr. Wang, a third year resident explained to me that even if nurses have already taken a breathalyzer reading from a patient, but police must obtain separate permission for this information--permission that most under investigation will not provide.

Doctors in the ER acted coolly and professionally. Although faced with a myriad of bizarre and often belligerent patients they still used "sir" and "ma'am" when talking with patients and were not easily flustered. One doctor, visibly pregnant through her scrubs, had a particularly calm and authoritative demeanor. When a patient began to get violent during their assessment, she belted "security" down the hall and took a few steps back.

In addition to the doctors that I observed and spoke with, there are many other important players in the ED. Security personnel work hard to protect the other workers and patients themselves. At one point a security officer translated for a nurse who didn't speak Spanish, allowing her to better communicate with her patient. EMTs and paramedics also play an integral role in allowing the ambulance triage area of the ED to run smoothly. Many are familiar with the nurses and will help transport a patient or restrain a patient if extra hands are needed. Those from the Providence Fire Department could often be seen grabbing a short break at the hospital with one another while waiting for their next call. Usually they would get a call before they could even get back to their station. Nurses and CNAs had a majority of the patient contact during a patient's stay. They did everything from administering medications to getting blankets and making patients comfortable. A number of times, they had to endure belligerent patients yelling obscenities at them for an hour on end while they did their job. There were even official ER observers who walked through the trauma rooms with high risk teens and emphasized the consequences of risky behaviors behind the wheel and with drugs and alcohol.

ER doctors had to be team players. They worked with numerous colleagues, whether their respective attendings/residents or specialists and, as shift workers, transferred patient care at the beginning and ends of their shift. I heard them often consult one another while making difficult decisions, and even compare general impressions with a few highly experienced nurses. Because it was a generally slow night for the ED, a number of different doctors took time to answer my questions and explaining what they were doing and the rationale behind it. At one point, they motioned for me to follow them into the CT scan and I was able to watch one performed on the head of an intoxicated patient and explained the procedure. I enjoyed the opportunity to see so many different physicians interact with their patients forming patient-doctor relationships rapidly out of necessity.