A little something different... I have to write a "letter of intent" to the director of education in the Baystate emergency department as part of my application to do an elective there. I'm not totally sure what should be included in one of those, but here's what I've got. What do you think?

I first became truly aware of emergency medicine as a summer camp counsellor in rural Vermont. With so many children running around in the woods for so many hours each day, accidents were bound to happen. Coincidently I was around several of the worst ones, and felt horrible that I didn’t have any skills to deal with it. A friend steered me towards a wilderness emergency medical technician class, and it was exactly what I was looking for. It gave me a way to approach “the sick and injured”, as the text book says, and consequently how to take each emergency in stride.

From there I went on to use my skills in the more formal setting of an emergency ambulance service. In that environment I was introduced to the breadth of patient population, variety of medical, surgical, and social complaints that occur in a day, as well as the odd mixture of intense excitement and dreary routine that emergency medicine offers.

Several years later, I find myself in a position to advance my medical knowledge and practice, and am exhilarated by the chance to get to sample and learn so many different aspects of medicine as allowed by program in the fourth year of training here. I find it easy to get excited about each new subject -- cardiology, nephrology, neurology, ophthalmology, urology. But how could I possibly choose between them? There isn’t a single body part that is without wonder, a single organ system that doesn’t awe and intrigue me with its intricacies. Of course these thoughts take me to emergency medicine. What better place to be to see a wide variety of pathologies than an emergency department? The variety combined with the fact that so much of emergency medicine is based on problem solving is extremely appealing.

Though I sometimes wonder if I would miss the ongoing relationship that is found in a primary care setting or with other chronic conditions, I also have cause to remember all of the unusual relationships formed between emergency staff and the repeat customers to the emergency department. Perhaps they aren’t the archetypal physician-patient relationships of old, but they are just as important to the people in them. I also learned how to create rapport quickly with my patients in the ambulance, and I think that is a skill that will be quite useful to me in a career in emergency medicine.

It is hard for me to see too far past my immediate future; I have so much to learn in the remaining year and a half of school, and many years of education after graduation. Emergency medicine offers a lot of choices that suit me in that regard as well. I would like to get involved with prehospital care again, and I would like to expand that interest into disaster medicine. Though most specialties can be useful at a mass casualty incident, the aspect of emergency medicine that is making organization out of potential chaos is attractive to me.

I also believe I have a lot to offer Baystate. Since I grew up in Amherst I have the desire to care for the community that Baystate serves. My time at the Caring Health Center has introduced me to a part of the local population I was unaware of, and now have a good idea at some of the struggles the underserved population of western Massachusetts faces. My undergraduate degree was in Russian Studies, which I believe leaves me especially able to communicate with a large portion of the immigrant population of the Springfield area. My time as an EMT working in a busy city has shown that I can handle, and even thrive in the hectic atmosphere that can be emergency medicine, and my other life experiences have taught me both how to be a good team member as well as how to lead.

I look forward to the opportunity to work and learn at Baystate. I think we have a lot to offer each other. Please do not hesitate to contact me with any questions.

Wowsers. Zounds. Gadzooks. It's been an exciting couple of weeks in the maternity hospital. A particular highlight was when I stayed until 2 in the morning with one of the SpRs while he was on call. In the course of the day I saw 3 forceps deliveries (including the rarely seen beast of a Kielland forceps assisted turn without an episiotomy), 2 ERPCs, and 4 c-sections. Two of those I scrubbed in on simply to stand closer to the action, but for the second 2 I was actually the obstetrician's assistant.

I was struck by a number of things that night:

C-sections smell funny. It is likely that all abdominal surgeries smell funny, but so many of the ones I have seen have been laparoscopic so they weren't as fragrant.

The first cry of a baby as it gets pulled out of the uterus is amazing.

I imagine c-sections might feel anti-climactic to the parents. After 10 months (where did this 9 month figure come from anyway?) of pregnancy, 10 minutes later they're holding their baby (shoot, only two forms of the word 'there'). I realize there are a lot of good reasons for having a c-section, but in my inexperienced mind labor is an important part of the entire process.

Those of you who are parents might be familiar with all this, but it has been exciting to experience for the first time.

I've also been to many clinics, both obstetrical and gynaecological, and so have seen consultations with woman with uterine and ovarian cancer, prolapsed wombs (a better sounding word than uteruses), amennorrhea, and other problems. The doctors are all wonderful, both to their patients and to their students. Encouraging us to stay late and get involved, and making sure we're getting exposed to as many different aspects of the specialty as possible. It's been a real treat not to feel like an after-thought.

Ciao.