A DAY IN THE LIFE
A Day in the Life of Pediatric ED Doctor
by KATIE NICHOLS , MD
For the last 12 years , I have worked in the Pediatric Emergency Department : initially as a clinician straight out of residency , then my fellowship for three years at a trauma center and for the past eight years in a community pediatric ED .
Most clinical days as a pediatric emergency medicine ( PEM ) physician are similar to a “ choose your own adventure ” book – with the patients choosing the adventure for me . While the work of seeing patients , reassuring parents , charting and billing will remain consistent , there is no consistent schedule nor appointments to be made . Some days start slow ( like during a morning shift ), while afternoons and evenings will typically be very busy , though the pace can slow into the overnight hours . Even after 12 years , it is still difficult to put into words what my days are like . My shifts will always be at different times and days of the week . I will work holidays , nights and weekends while many docs are with their families or enjoying time off .
Most of my daily work involves more minor illnesses and injuries : ear infections , upper respiratory infections , sore throats , etc . Many visits will be reassuring parents worried about their children . But then there are the dreaded cases that are the reality of working in the ED . These are what many think of when envisioning the ED : cardiac arrest , sepsis , severe trauma , burns , child abuse , new cancer and brain tumors and so on .
Although the cases vary daily , many days follow similar patterns based on the time of year .
Summer months tend to be when the volume is lower . There will likely be more injury visits : broken bones , laceration repairs , falls and water exposure to name a few . As kids head home from school for the summer , typically our illness visits will decrease , allowing some days to catch up on education modules or CME .
The fall months will bring the dreaded bronchiolitis season . Waits will likely be high , and the stress of busy shifts will increase . Many days will involve lots of infants needing nasal suction and having to decide who will require high flow oxygen to help them through the illness . Some days will require intubation discussions as well .
Winter typically brings the high-volume flu season and ongoing asthma / respiratory illnesses . Depending on the flu strains , the shifts can be extremely busy . While office appointments will fill to
12 LOUISVILLE MEDICINE a limited volume , the ED volume does not cap and continues to increase . Patients can sometimes be seen seated in our hallways and common areas to help alleviate space issues .
Throughout all the seasons , some things are constant . There will always be fevers in neonates that require sepsis work ups and lumbar punctures , seizures , drug ingestions ( both accidental and intentional ), depression , suicidal / behavioral health visits and motor vehicle / bus accidents to name a few .
But the hardest days for me are the ones that you always dread : critical patient visits , and even deaths .
Throughout my shift , my calm exterior is ready to jump into action at any minute . When I hear the rapid beeps of the EMS radio , my heart rate will always increase as I wait for the paramedics ’ information . When I see someone running down the hallway , I immediately switch into crisis mode . I can hear it in a nurse ’ s voice as they yell my name , that a child is very ill . But I ’ ve learned over the past years that many patients will not come by EMS or arrive needing immediate attention . More difficult cases such as gunshots , stabbings , medical arrests and birthing moms give me seconds to start my management , instead of the minutes that I get from the ambulance report .
The ED setting can be difficult , because having one critical patient does not mean others won ’ t arrive . I may have a child receiving CPR in one room and a seizing child in another . I ’ ve even had twins come in seizing at the same time . Leaving a room where the unfortunate death of a child has just occurred , only to return to the busy ED waiting area to treat the rest of the patients , can be a very difficult reality some days . Balancing those moments is what can make the pediatric ED very stressful .
My support staff is an extremely important part of how well the care and management of the patients goes . Good nurses , respiratory therapists and pharmacists who can help in the most critical situations can make difficult days easier . They make every day easier .
A day in my life in the pediatric ED is always different . Working in the ED , my guard is never down until I ’ m walking to my car . While the first nine hours may go well , I always know the last hour could change that instantly .
Whether it ’ s busy or calm , stressful or routine cases , I never know what my day will bring .
Dr . Nichols practices at Norton Women and Children ’ s ED and Norton Children ’ s Hikes Point .