The Road through Residency:

Rollercoaster

The warm air kicks up dust from underneath the wooden giant standing before me. Metal rails guide the patrons from the beginning of the line to the small covered house at the end. I suddenly hear a loud whirling, and a rush of air blows past my face. I look up, too slow to catch a good look at the speedy demon, which is only a red flash at the edge of my vision. Clenching the metal rails tightly, heart racing, I wind through the maze and stand waiting at the end of the line. It's quiet in the covered house with no walls, where attendants wait with 'you-must-be-this-tall' hard plastic tubes in hand.

Suddenly, the ground shakes, and the red flash bursts into the house and slows to a halt. The riders get out of their harnesses, ladies with their long hair frizzy, and several young teenagers missing baseball caps or sunglasses. They look exhilarated. I move into a seat and pull the harness over me. The coaster juts out of the house, and I hear the tick-tick-ticking of the chain, pulling us up to the top of the hill. My heart races, hair stands on end, sweat begins to flow, and I look out over the rest of the park before I stare down into what seemed, when I was eight years old, like certain death. I close my eyes and put my hands up.

I open my eyes to reveal another exhilarating sight. The patient on the stretcher in the hallway is retching into an emesis basin. Another lies on his side, holding his left flank. Still another sits puffing through pursed lips turned a pretty hue of purple, laboring to push air into her lungs. I've come full circle now, having left the emergency room as a technician and returned a physician. I remember what I had forgotten; how such a small, enclosed space in the hospital can hold the majority of the drama and excitement.

I snap out of my reminiscing and grab the next chart in the bin. A 78-year-old female, post-fall onto the face. I make my way into the room while darting this way and that to avoid the barrage of nurses, family members, patients and physicians parading through the hall, minds focused, concentration on edge. The patient lies on the stretcher, a cervical collar around her neck, her hands shaking.

"Miss what happened today?"

"I'm nauseous. My head really hurts."

"Did you pass out when you fell? Did you trip over something?"

"I'm nause-"

She turns towards me and vomits onto the floor and my left shoe.

"It's okay." I keep my hand on her neck, stabilizing it until her nausea abates.

"I'm sorry."

"Nothing to be sorry about. I didn't like these shoes anyway."

My exam doesn't show anything too concerning. Her pupils are a little sluggish but equal, and there are no focal deficits. I order a CT scan of the head and some pain and nausea medication. I make my way to my attending and give him my presentation on the run, while he paces quickly, getting work done.

"Sounds like a good plan," he says. "We'll keep a close eye on her."

I move on to my next patient, a 45-year-old female who wants to throw herself in front a train. As I walk into the room, the patient breaks out into tears about her boyfriend, finances and how all she thinks about are exotic ways to end her life. I sit, listening, nodding, holding her hand. As I leave to close the door, she asks for a warm blanket, a Vicodin, and a ham sandwich, no cheese.

Later, I sit down at the computer and bring up the CT scan for my elderly patient with the fall. Staring back at me are two subdural hemorrhages. I quickly walk back to the radiology department. The patient is lying on her stretcher in the hallway. She is still neurologically intact, and I start pushing her back to her room, explaining what we've found. I ask the unit coordinator to page the neurosurgeon immediately. As she does, another patient grasping his chest wheels through the door of the emergency department on a stretcher. I close my eyes and feel myself winding up and down the tracks of the rollercoaster, through loop-the -loops and corkscrews, before bursting back into the small covered shed and coasting to a sudden stop. I open my eyes and realize the only difference is the excitement of the rollercoaster lasts less than two minutes, but I still have eight hours left in my ER shift.