By Katie Collins
Every night at 1915 I get a text message alerting me of my upcoming shifts. Before each shift I put on my orange and blue scrubs, mismatched socks, and my orange gator crocs. I make sure my watch is on and my water bottle is packed. I place at least 3 pens-blue, black, and a ‘fun’ color- a sharpie, my trauma shears, a light, and my measuring tape in my various pockets. I grab my backpack, jacket, and ID badge and head out the door 30-40 minutes before the start of my shift. With each step taken from my car to the ambulance bay I try to think what my imminent shift will hold for me, but no two shifts in the ED are ever the same. The automatic doors open, I take a cleansing breath, and am ready for whomever and whatever I may see in the next 10 hours. With my laptop in hand, I seek to find the other scribe on shift to see where I will primarily be based at– CORE, trauma/resus, or Rapid Assessment Zone (RAZ).
Where my base will be for the shift depends on my fellow scribe(s) working the 0700-1700 with me. We both meet in RAZ and make a game plan. Since we are the only two scribes for the next 2 to 4 hours, covering 29 beds in the COREs, 14 beds in RAZ, 4 trauma beds, and 2 resuscitation beds we have to work together as a team. Even though I will be going to CORE for my shift, I know that the RAZ scribe will be watching my back and seeing if they can be useful in the cores or trauma/resus if I’m getting overwhelmed. Just the same, if they are seeing more patients in RAZ and the COREs are locked up (having admit beds or all the patients have already been seen) they know that I will float to RAZ and help them see patients until I am needed in CORE again. And we both will be listening for those pager alerts for patients headed to the trauma/resus bay.
As the shift goes on, scribe coverage increases. If it’s Monday, Tuesday, or Wednesday there will be a screening or triage scribe working with an attending in the waiting room. There they will screen the patients whom are waiting, writing brief histories and start the patient’s treatment to expedite their care.
If it’s Thursday through Sunday, there will be a 0900-1900 scribe coming on where they will mostly likely go to either CORE 1 or CORE 2. At this point there is a scribe in CORE 1, CORE 2, and RAZ, meaning we have full coverage! Even though we are each based in one area, we have developed a 7th sense (the 6th being knowing where a provider is at any point while on shift) to know where we are needed most. It is not unlikely to have CORE 1 with no new patients and at the same time CORE 2 gets 3 new patients and 2 EMS stretchers in the hallway. When this happens we know that the both CORE scribes should be in CORE 2.
At 1100 another scribe joins the team for the day. If we have a triage scribe, the 1100 scribe will help staff one of the cores. If there is not a triage scribe, the 1100-2100 scribe becomes the floater scribe (although we are all truly floaters) where they float through all three CORE, going where they are needed most. They will also primarily be staffing trauma/resus.
During each shift we can see anywhere from 15-40 patients, depending on the day, location, and who we are working with. Typically, while working as the 0700-1700 scribe the day can start off slow as the night shift emptied the waiting room. As the patients trickle into the ED, we become increasingly busy, as the beds fill up, patients get admitted, and the waiting room fills back up. Within hours we can go from 0-10 patients in all of the ED beds to all 41 CORE beds, plus 20 hallway chairs, 4 trauma beds, and 2 resus beds are full and pending dispositions. At this time the ED seems less like a systematic flow of patients and more towards an organized chaos. Trying to dodge EMS stretchers that are entering two by two, the patients and their families asking you for updates (even though we are not qualified to give any), and the other members of the ED team going from room to room trying to do their job as well. All the while, getting alerts on the scribe pager and trying to figure out what CORE you can be most effective in.
What is interesting about the ED is how each patient has a new and unique medical complaint and no two charts are ever alike. You could be in one room seeing a NSTEMI patient with chest pain and all the associated red flags and walk out the door to a hallway patient with toe pain that has been ongoing for 20 years. The experiences you gain while working alongside providers is incomparable to any other pre-med/pre-PA experience. Not only are you learning the basics of charting and medical documentation that will be a skill you’ll need every day in your medical career, but you also create mentorships with the providers that help guide you through your application process. Being in the ED, the patient encounter allows you to observe valuable skills of patient care, bedside manners, and patient advocacy as well as learning tidbits of medicine from each patient experience.
After 10 hours on shift in the Adult ED, seeing on average 20 patients, writing approximately ten thousand words consisting of the patient’s story of why they are in our ED, filling out physical exams, and writing up the patient’s plan as told by the provider, the PM scribes begin their shift. Over the shift, I have worked with 2-6 providers from attending physicians, residents, nurse practitioners, and physician assistants. I’ve learned at least one more tidbit of medicine from evaluating chest x-rays or understanding how we treat DKA. There are good shifts and bad shifts, and shifts that are physically and emotionally draining, but overall all shifts are rewarding and are confirmation that I want to pursue a career in medicine.