emt gone pa, can you say ERPA?

It was a long road from the streets of Harlem to the ER in Brooklyn. You wouldn't think so since they're only 12 miles apart separated by the east river and my favorite, the Brooklyn Bridge. In 1999 I entered the FDNY EMS academy. It would be almost 2 years before I even knew what a PA was (thank you PA Braithwaite) another 2 years before I would be accepted to PA school and another 3 years before I graduated. Tack on two more years before I would be hired as an emergency room physician assistant and you've got 9 years from emergency room to emergency room. A long road indeed, but a damn good one.

Being on the receiving end of emergency medicine is what I dreamed of when I was an EMT. I began plotting how I could practice emergency medicine practically the day after I was assigned to my station. Don't get me wrong. I loved being an EMT and the stories I have from nearly 5 years in the streets could fill a book and make the most cynical person's jaw drop or roll on the floor laughing. Today the stories have changed likely in part to the backdrop (almost anywhere outside the ER vs the ER)and we're tending to their illness and injuries which can be a considerably serious business (though not always).

Still, topping my list of interesting folks and stories, after a mere two months in the ED are:

- The woman who came in with puncture wounds on the top of her head from a hand saw: he was walking down the sidewalk on her way home from church and a man sawing a tree branch on the other side of a fence over-extended on a downward thrust and hit the top of her head with the saw at the end of the motion. He was profusely apologetic and blew it by offering her money not to call the police/ems. When she explained she didn't know the extent of her injury and should be examined, he bolted. Makes you want to move to NY, no?

-The young woman who over-extended her hand while sewing with a sewing machine and the the needle went through her fingernail and finger - I saw her in the ER (quietly in tears) after she was seen in the Ortho clinic the day before for follow-up of the original treatment (which included removing her fingernail because of the swelling). They told to soak her finger and see them in a week. It looked like the top of a tootsie-pop compared to the rest of her finger; red, swollen, nail removed and oozing nasty green stuff (exudate). Warm soaks? Nice guys, nice. We had our lovely Ortho resident come and drain it. The woman almost passed out and since our resident is totally great but not a talker, I held the fingers steady and chatted up the patient to get her through. It worked, and MAN did she have a lot of shit in her finger. We admitted her for pain control eventually. Warm soaks..yeah, right.

-The mystery man - a young built, educated guy who said he had bilateral foot surgery 6 weeks ago without incident or swelling. He'd gone for weekly check-ups revealing good healing and no swelling. In the 5th week he had the flu that laid him out, but then totally recovered and then in the 6th week his feet swelled up and he got this weird looking rash: small deep red flat circles that didn't blanch when pressed - only on the bottoms of his feet and medial malleolus (inner ankle). My first thought? Syphillis. But it wouldn't cause the swelling of the feet. Heart failure? he was healthy without heart problems. DVT? It was bilateral without respiratory symptoms or cramping. Infection to the surgical site? No sign of it, and again, both feet? The MD I was working with was stumped as well (which made me feel good). I ran the short list of symptoms through my epocrates and one dx that jumped out at me was Nephritic Syndrome. So we ordered labs and waited to see. I was thinking with the flu-like symptoms, post-step glomerular nephritis made sense, but he didn't have a sore throat and he wasn't a child. But all the same, the labs came back and nephritic syndrome it was - we called renal and admitted him. Better yet, the MD I worked with that night found me weeks later and said " did you hear about our guy?" (By now I'd seen many "guys") "Which one?" I asked. "The guy with the nephritic syndrome" he replied. "oh, what about him?" - Syphillis :)

So not the same as a guy cutting his chest with a circular saw by accident, nor a shooting or stabbing, nor edp's too numerous to list. But hey, I've only been there 2 months and I love it. Sherlock Holmes in bright green scrubs - seriously, what could be better?