Today I’m going back to the emergency department to work.  I’ve been off for two weeks.  I’m thankful for my vacation; it was fantastic.  But going back is always a little, well, dicey.

The first time I walk back into the department after a break, I look at the faces of my co-workers, trying to read them:

‘Does he know about Mrs. Krabowsky?  The patient with the infected toe that he discharged and who became septic and died the next day?’

‘Wow, he doesn’t realize we lost the contract and have to move or work for half pay!’

‘Hey, didn’t we elect Ed to work the full-time night position during our last meeting, the one we had while he was on vacation?’

‘Poor guy, he doesn’t know about the stack of subpoenas in his box from the bus wreck when everyone had subtle cervical spine fractures and were all subsequently paralyzed!’

But it isn’t just the faces.  I worry about the first words:

‘Hi man, welcome back!  Hey, do you remember Mr. Garrity?  Yeah, the one you left with me to discharge because you thought his chest pain wasn’t anything?  Well, turns out they gave you the wrong EKG.  It was the weirdest thing…but I wouldn’t worry about it.  The hospital attorney says he thinks we can settle…’

So it is always with a bit of trepidation that I go back to the ER.  And I also return wondering just how much of my medical education has slipped out of my head during my time off.  Honest doctors must admit that it takes practice to practice well.  No matter how much people in the ivory towers want us to believe that articles and tests make us competent, those are only a smidgen of good medicine.  The rest is seeing people, recognizing sickness and injury, and knowing what to do.

So, for the first 6 hours, I expect my brain to reprogram itself from ‘where can we eat with all four children without donating plasma,’ ‘is that Bison about to charge the rental car,’ and ‘wow it’s a lot more comfortable at 10,000 ft that it is in South Carolina,’ to ‘the head bone’s connected to the neck bone, the neck bone’s connected to the…the…I guess back bone.’  I forget.

I can always tell when I’ve been off.  I see a fracture and call my ortho friends:  ‘Yeah, hey Jim, this guy has a broken, uh, well, you know the little bendy bone at the end of the arm thing, that people break when they, uh,’  (I probably sound like a stoner…’Dude, it’s, broken!’)  My friends hopefully say to themselves, ‘must be back from vacation,’ and look at the x-ray themselves.

But the worst is communicating with patients in my transient ignorance:

‘Well, Dr. Leap, what exactly is a myocardial infarction?’

‘I’m glad you asked, Mr. Fauxpas, because it’s when a blood vessel in your, uh, in your heart gets a narrowing called a, I mean, when you get too much cholesterol or stuff, or a clot and it moves to, um, oh!  I’ve been paged overhead!  I’ll talk to you after your thrombolytic!’

‘What’s a thrombolytic?’

‘Your nurse will explain it all.’

So, I hope that it’s a smooth one.  And I hope the same for anyone returning to their jobs after a long time off.  My God return us to a place where we were scarcely missed, where nothing changed except the smell of the coffee creamer, and where our errors had nothing to do with anyone’s well-being.


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