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Dear all,

Good morning! One week of emergency medicine down, one week to go! Halfway through, and my sleep schedule is already shot! “OTL We have 6 shifts of 8 hours each, and they can be anywhere from 8 AM to 4 PM, 4 PM to midnight, or midnight to 8 AM. I wish they would just give us all one time slot. Like, I wouldn’t mind the overnight shifts so much if I consistently had those, instead of switching between day shifts…but whatever.

On Monday we had orientation (and I also learned that I passed the surgery shelf by the skin of my teeth…that’s all I needed, anyway). My first shift was Tuesday, 4 to midnight. I got to see some pretty interesting things…

First off, we had a patient who came in because of shortness of breath. Pretty wide differential there. We did an X-ray and, I’m quoting my resident here, “Ahhhh! Holy shit!”

It turns out, he had coin lesions all over his lungs, markers of cancer metastasis. I’ve only learned of people having one or two on test questions, but nope, not this guy. He had dozens of them everywhere, with only shortness of breath as a complaint! With no prior diagnosis of cancer, we immediately shipped him to the oncology floor to do a full-body work-up. But he, a 40-something, relatively healthy guy, took it pretty well. Either that, or he was in shock. I hope he’s getting the proper treatment now…

Another patient (and her family) I saw really didn’t like me, haha. My first mistake was saying I was a medical student. She kind of rolled her eyes, and answered all my questions with one or two-word answers. Then I asked her if she smoked, and she screamed, “NO! I DON’T SMOKE, DRINK, OR HAVE SEX!” One of her children glared at me and said, “Just get the doctor for us.”

Standard Step 2 CK answer: “I understand you’re upset. However, these are questions that I have to ask all patients if I think they are relevant. Also, my resident is busy taking care of other patients, but if you’ll bear with me, I’ll get him as soon as possible.”

My actual answer: “S-sure.”

Assertiveness is one thing that I still haven’t quite gotten the hang of, haha…

Another patient was having benzodiazepine withdrawal. Oh, a drug-seeker, you think? My initial thought, too…until he showed us his prescription bottle that stated “7 mg PO q24” from his primary care physician.

7 mg.


It’s doctors like this that are causing the addiction epidemic…dear readers who are going into primary care, please don’t prescribe 7 mg of clonazepam to anyone. If they really need benzos and lower dosages aren’t doing anything, then do the right thing and refer to a psychiatrist, so we’ll be able to keep an eye on them (and, you know, do our psychotherapy magic). Don’t keep titrating upwards and hope for the best unless you really know what you’re doing.

Speaking of psychiatry, I got to see a patient with suicidal ideation, who had come in with his mother. The patient was in the bathroom when I went to his curtained area, so I introduced myself to his mother, saying I was a medical student. When her son came out, she introduced me as a nursing student.


If I was a nursing student, I would have said “nursing student.” Saying “I’m a doctor student” doesn’t sound right. “Doctoring student” sounds even worse. “Physician student”, what does that even mean? Actually, that’s probably a resident or something…

And another thing, I don’t think they would send a nursing student in to do a full history/physical of an acutely suicidal drug abuser with a history of schizophrenia and bipolar disease. Not that they wouldn’t be fully capable of that, but nurses triage so doctors don’t have to. Ugh, well anyway. I reintroduced myself as a medical student without correcting the mom, just because I couldn’t be bothered to.

Midnight rolled around after a while, and I went home and slept like a baby…for like 6 hours. SURGERY HAS RUINED MY SLEEP SCHEDULE FOREVER.

On Wednesday, I studied and played Fire Emblem: Fates. (Hisame is Hinata and my son and exactly what my son would act like in real life. Kind of moody, quiet, and striving for his parents’ approval. Kana, my other child, is super annoying and I don’t like him as much. I miss Morgan from Awakening, haha.)

On Thursday we had ACLS training, and I played more Fire Emblem. (Gods, I hate Subaki and his daughter. They’re written to be too gods dammed perfect. I kind of hate this trope of “Flawless Pegasus riders”. I wanna kick their faces in.)

On Friday, I had my first graveyard shift from midnight to 8 AM. Some cool things I got to see were a dental block for tooth pain (needle inserted above the gum to numb cavity pain – take care of your teeth, people) and how an echocardiogram works. Also apparently ED physicians don’t give Tamiflu to people with the flu because sometimes makes their flu symptoms worse. Everything I know is wrong. “OTL

More, uh, funny things that happened were there was a patient with a history of malingering who was in because his 4 20-something-year-old grandsons beat him up (???). Septal deviation and abdominal bruising. But he refused to sit still in his room and roamed the entire ED despite reprimand from the nurses. Then he left the ED to smoke for a few minutes before returning and asking for a Mountain Dew.

10/10 pain, my ass.

My attending, after getting several complaints from nursing staff, finally took action and told him straight up that he had two choices. He could stay and receive the medical care he needed provided he stay in his room, or he could leave AMA. The patient said it wouldn’t be leaving AMA because “you aren’t doing the proper medical tests”. (We were waiting for his abdominal CT results.)

In the end, he left, but not before asking for a Mountain Dew. The attending coldly replied, “This isn’t a restaurant.”

Anyway, that’s about it. I walked back on Saturday at around 7:30 because the resident let me go early, haha. I went home and immediately dove into bed (for like 5 hours, ugh). I got up, and did some questions (since I can’t game all the time) and watched some lectures, then slept.

Today, I bought some fruit at Wegmans, and now that I’ve finished this newsletter, I’ll go for a run or something. Trying to get in shape for swimsuit season. Haha, just kidding. I’m probably not going to wear a swimsuit this year either because I hate swimming and the beach.

And on that note, see you next week, for the LAST EPISODE OF MSIII SUMUN!!!

Most Sincerely,
Annette Liem

~Sarcastic Quote of the Week~
Attending (12 to 8 shift): “It’s the weekend, so I’ll finally be able to see my wife and kids before going to sleep!”