It’s the first day on my 4th-year elective in the emergency department. I had orientation in the morning and just my luck I am scheduled for a night shift. I had the good fortune of finding an emergency physician in New York who let me shadow him before my rotation, but the truth of the matter is, I had no idea that what I was getting myself into. I guess I’ll just jump into the deep end. Sink or swim.

I walk through the double doors into the main area of the county ER. Simply put, the place is buzzing. I have never been in this type of environment. There are ambulance gurneys lining up and down the middle of the department with screaming patients. Curtains are separating intubated patients. This feels like a war zone, and I have entered the trenches.

Halfway through the shift, I’m Instructed to go to bed 1 with the senior resident.

“What’s coming in?” I ask looking like a deer in head lights.

“We’re getting a run. Young guy. Multiple GSWs (gunshot wounds). Unstable in the field. Get ready. Have you ever put in a femoral cordis?” He responds coolly. For what’s coming in he seems oddly relaxed. Like a seasoned veteran who is not phased by anything anymore.

“Nope,” I respond.

He sizes me up and responds, “OK well at least get ready to do compressions.”

Before I know it the trauma bay is alive. The trauma surgeons have come down. An army of nurses and techs surround the empty bed priming IVs. Anesthesia is now standing at the foot of the bed. The monitors beep every second as they wait impatiently for the patient to be connected to them. All of a sudden the mechanical double doors crack open and the patient rolls in. Two paramedics are pushing the patient, while a third is literally riding the patient and performing chest compressions at the same time.

Without a skip of a beat, the well-oiled trauma machine goes to work. In a frenzy of action, CPR is continued, my senior resident intubates the patient, a cordis goes into the right femoral vein, chest tubes go into both sides of the chest simultaneously. I step onto the stool and continue compressions. I hear and feel nothing but pure adrenaline. Seconds feel like hours. In what feels like an eternity I begin to realize how physically demanding doing chest compressions is. I’m starting to sweat. My arms are starting to feel like lead. “Don’t be a wuss,” I think to myself. I suck it up and press on, harder, faster.

They call it.

I step down. Adrenaline still pumping.

I take my first few steps away from scene and feel a squish in my shoe. I look down at my pants, and they are soaked in blood. Blood must have been shooting out of the patient’s chest tubes every time I beared down on his chest. This was my initiation into emergency medicine. A bloody baptism of sorts.

Shift ends.

I keep reflecting on that case. I keep replaying what happened. Trying to figure out how I can become bigger, badder, stronger. And then I start thinking about the patient. What was going on? What was his story?

The contents of his pockets were checked. A condom, bag of weed, and stack of cash. Wow, looks like this guy was going to have an epic night before he was lit up. He was probably going to hit up a party, get high, smash some chick, and ball out. Too bad his night ended a little prematurely. That night I learned that life is short, and you never know when you are going to die. So always carry a condom and live life like there is no tomorrow.

Zahir Basrai is an emergency physician who blogs at the Physician Grind.

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