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It’s about 1 in the morning, at a decent-sized community hospital near the middle of the state. EMS calls in that they just picked up a real sick guy out on the highway, complaining of abdominal pain, and they’re giving vitals over the radio: Classic shock picture. Fast heart rate. Check. Fast breathing. Check. In and out of consciousness. Check. Can’t get a blood pressure. Weird, the machines…

Seeing: Out at my mid-state site. It’s a large community hospital affiliated with a bigger hospital group; their flagship facility (what we call a “tertiary care center”) is in the city an hour south. It’s midnight. My 4p partner is wrapping up his shift and getting ready to handoff his cases to me, when we get a squad call. They’re rolling towards us with a guy who has a blood pressure in the…

Scene: Set in rural Appalachia, where I’m the only ER physician for 30 miles in any direction. It’s maybe 1 am on a cold, clear night in September. A lady comes in with chest pain. She’s only a few years older than I am, and fairly healthy, but one look at her face and you could tell. She’s pale and sweaty, and she looks scared. So, even though she doesn’t have a whole lot of risk factors for…

It’s been about 8 months now of doing this on my own, and I’ve been employed in several different environments since then. The first place I got hired was with a locums group, and I travelled out to the middle of rural Appalachia to this little hospital group in an underserved area. The hospital was built by a surgeon back in the 70’s who brought all his buddies out to the middle of nowhere with…

~trigger warning, graphic content~ I’m graduating residency on Friday. I’ll be eligible to take my final specialty board exams and will be working as an attending on my own. There is much to celebrate. And I’m both elated and terrified. This week, I had a young woman brought in by EMS, in her 40’s, in cardiac arrest. She had been out with her kids for her birthday dinner, and when walking to…

Thoughts on trauma processing, part 2

Emotions are messy. They’re sloppy and frequently slosh out of their proscribed little boxes into nearby emotions (or not so nearby ones) and sometimes it’s hard to tell which box they were supposed to belong to in the first place. We try to conquer them by giving them names and definitions and end dates, instead of just experiencing them the way that they are, for as long as they last.  This…

I’m in my 4th year of residency now. About two-thirds of emergency medicine training programs in the country are three years long, and the remainder are four years. I’m in one of the latter. That means that a lot of the people I went to medical school with have already graduated, and are moving on to start working attending jobs across the country. I still have days where I feel that I’m never…

I was up in the ICU overnight the last night of my third year, covering a shift for a fellow resident. I’d spent the last four months off-service, rotating at other hospitals, and this was my first shift back at my home institution in ages. It was supposed to be really chill, there were only 3 critical care patients I was covering, and I had backup coming on the way in. We had three available…

It’s July. For me, that means the end of another academic year in residency. Most residencies are three years long, and that means that around half the people I went to medical school with graduated residency last week, and are moving on to working in their own practices, taking their first jobs as fully-fledged physicians. In Emergency Medicine, about 2/3 of the programs are 3 years long, and…

A tour of the last year or so…

I’ve not posted in a while. It’s not that I haven’t written, It’s that my thoughts have not been really fully formed, so I’ll have things I want to talk about, but I’m not really sure how to process them or what I really want to say, so I’ll leave the post half-finished, thinking I’ll come back later. But, in the nature of terminal ADHD, I never come back to finish it. In that spirit, please let…

I had a moment tonight of intense clarity. I’m sitting in my armchair and it’s 3am. I just turned off the television that’s been keeping me company the last few hours since I left work. I’m sitting in the dark, the only sound is the subtle hiss of a candle flame burning on the side table, and the dog breathing quietly in his sleep curled up in the couch. I can see the brick of the fireplace…

Three Years: How Not to Date, Part 6

Three years ago, as of yesterday, he woke up early on a Monday morning and kissed me goodbye for my first day of clinical rotations. Then he climbed into his U-Haul, and drove away. Neither of us knew how to make a long-distance relationship work. Neither of us knew if it could. In the last three years, we have spoken on the phone nearly every day: sometimes early in the morning before a shift,…

Knowing What You Know Now…

Riding our bikes to go get ice cream. Maintaining a sense of “normal” among the otherwise crazy days. If you could go back, knowing what you know now, what would you do differently? The question is odd to me for many reasons. The implication, of course, if it were possible to go back, is that I could change the choices that I regret, and somehow keep the lessons those mistakes have taught…

How to Be a Spirit-Guide: a non-motherly Mother’s Day post

The word “psychopomp” from the Greek ψυχοπομπός, means a “guide of souls.” They exist in many mythologies, as the entities that aid the transition from living to dying. In Greek mythology, Charon ferries them to the underworld across the river Styx. The Valkyrie carry the best warriors to Valhalla. The servants of Anubis handle dead souls in ancient Egyptian mythology. Modern christianity…

It’s been almost a year that I’ve been here, learning how to be an ER doctor. I love my work. I love the action and the drama and I still love the fact that people come to me oftentimes having the worst day of their lives, and even if I can’t always fix it, sometimes, just being the calm voice in the eye of the storm is enough to get them to the next step. Sometimes, though, I can’t help. I was…

A Brief History of Me: a Talk I gave to the Aspiring Emergency Med Students at my School.

I was asked to speak to the 1st and 2nd year students at my school about my story and my experiences pursuing Emergency Medicine. This is the first part of that talk.

Hi, I’m Angela Sales, and I’m a graduating 4th year. I am headed to Cleveland, Ohio next month to start my Emergency Medicine residency.

A little about me: I’m a non-traditional student, in the strictest sense possible; this is my…