My Experience Scribing in the ER

There are many advantages to being a medical scribe as a pre-med student. Aside from improving your resume for medical school, scribing provides a lot of opportunities to experience some amazing things. Here are some stories from my scribing experience demonstrating that this job can provide you with front row seats to life as a physician.

In order to honor my HIPAA oath, I will not provide the gender or age, hospital, time or day, and any other details that could be traced back to any of the patients below.

My First Experience with a Code Blue

This was a very strange experience, to say the least.  In order to honor my HIPAA oath, I will not provide the gender or age, hospital, time or day, and any other details that could be traced back to the patient that was coding.

I’m in the ER during one of my training shifts.  It’s a relatively slow day, and I’m busy trying to put in patient information into our extensive charting database.  Then the loudspeaker turns on and begins calling for my doctor repeating the words code blue in room X. 

At that moment, my trainer and I, without saying a word, walk over to where our doctor and some nurses were already waiting by the elevator that would take us to the floor with the code blue.  I did my best to keep cool and act like I’ve seen plenty of cold blues like any other day of the week, but in reality, I had an uncomfortable mix of excitement and nervousness that made my heart race and body jittery. 

We get there, and the room is packed with nurses and doctors surrounding the individual in cardiac arrest.  One nurse was doing chest compressions, making the body flop up and down on the table.  Two, maybe three, doctors were sticking the patient with needles and tubes in multiple areas.  And then there were maybe an additional four or so nurses passing syringes, needles, and tubes from the crash cart. 

For the longest time, ten to fifteen minutes, there was an obstruction in the patient’s lungs preventing the body from being oxygenated, giving it a discolored purple appearance.  When the doctor removed the obstruction, the patient’s color returned almost instantly after a couple of compressions.     

The way everyone ran around the room with a purpose made the whole thing very procedural, and at certain points, you almost forget that the person on the table is a human being.  I felt ashamed in a way because I was eager to learn and experience more at the expense of the patient. 

I know that’s not the right way to look at it because everyone was giving 150% effort into bringing the patient back to life, and I have to experience these things in order to become a physician, but still, a part of me felt like I should be mourning for this person I don’t know, instead of observing in awe.  Basically, the whole time I was feeling strange, conflicting emotions.

Finally, I have to bring this up because I feel like it may be a common misconception.  While the patient’s heart was in cardiac arrest, nobody brought out paddles and began shocking the patient.  The only time any shocking was done was when the heart was in a-fib, otherwise, the doctors and nurses would only use medications and chest compressions.

I don’t think I will ever forget about this first code blue. 

Further Reading: What is it Like Being a Medical Scribe

CPR in the ER

Technically this is considered a code blue as well but what was different about this code blue is that it occurred in the ER,  not the ICU unit. 

This is significant because 1) the doc I was scribing was now in charge of the code, 2) I had to be extra alert because I was required to document the event, and 3) the patient presented via EMS, so the patient was already hooked up to a machine and in a highly stable environment.

We got the call from EMS that the CPR patient was coming.  My doctor, a Physician’s Assistant, and several nurses immediately got busy setting up the room.  I stood outside the room and watched as everyone swiftly and smoothly set up the crash cart, took inventory of the supplies, and suited up with the proper protective equipment.   

When everything was ready and everyone was just waiting for the CPR to come in, the hospital seemed quite.  All the attention in the ER seemed to be in that one room.  At the bed where the resuscitation would occur, 3 nurses stood on the right side, two nurses and the ER doctor stood on the left, and the lone PA stood at the end of the bed with a surgical mask and eye protector. 

The PA looked at me and beckoned for me to come into the room.  I took my computer in and stood off to the side prepared to take notes.  EMS rolled the patient in. 

CPR looks nothing like the movies.  The patient’s body is flopping around because of the chest compressions, their eyes are open and bugging out of their head, and they are making grunting noises as air is being pushed out of their mouth during each compression. 

It’s not in the slightest bit glamorous as they portray it in shows.

In this particular instance, the compressions were being done by a machine.  This machine had two legs that attached to either side of the bed with a device in the middle that pounded down on the patient’s chest at a steady rate. 

The whole process was over so fast.  The doctor called time of death, the doctor talked to the family (which I was not present for), and soon we were all back doing our original job.  

Hours later I saw a woman lost in the ER.  I asked her, “do you need help finding a room?”  She said, “I’m looking for my husband, he’s dead.” 

I was one of the first people this lady saw when she received the news that her husband was dead, one of the most vulnerable moments of her life.  I was there when her grief began. 

My First Overnight Shift as a Scribe

Throughout my undergrad schooling, I had this irrational fear of overnight shifts.  For some reason or another, I believed that I would be incognizant and nonfunctional. 

Don’t get me wrong, I have pulled all-nighters before, but I consistently dreaded the idea of working nights as a resident/doctor.  Maybe it was because when you are working in a clinical setting, you are expected to finish the job no matter what, but when pulling any school-related all-nighter you have the ability to tap out at any time. 

Anyway, my overnight shift went completely fine, and it squashed that irrational fear.

The ER is an interesting place at night.  It is very easy to stay awake because of the constantly moving environment, essentially the same energy and atmosphere as the day. 

The only difference seems to be the patients the ER receives at night.  These patients tend to have more serious problems because most people with nonserious ailments won’t sacrifice their sleep and wait until the morning.

After only one hour of scribing, my ER doc receives a pediatric code from EMS.  Very sad situation, but luckily the patient survived.  The code lasted about an hour, which set us pretty far back making the rest of the shift fairly busy. 

After this initial code, we saw a fracture, a suicide ideation, a stroke, and various other maladies.  The doctor was very busy trying to keep up with her patients, so I spent a lot of my time helping her out by fetching labs and making phone calls as opposed to the actual charting. 

While scribing these cases, I get a better feel for how a doctor handles various situations that present to the ER.  The more I scribe the more I can see the value in such an experience for the pre-med journey.  Honestly, I don’t see why you would want to go into medical school without first experiencing something like this. 

Scribing, among other pre-med professions, truly gives you a feel for the field of medicine.  You aren’t only seeing what we perceive doctors to be on the outside, but also the intimate network of the hospital on the inside.

Scribing is preparing me for being a physician, giving me that edge which is crucial for getting into medical school.  Take advantage of opportunities like these — they can only help.

First Solo Shift as a Scribe

My first shift without a trainee was challenging. I was responsible for making every chart on my own.  I was already nervous because during every training shift there was always a moment when the ER got really busy, and my trainer had to care of things I missed during the confusion. 

Prior to this shift, I kept thinking about how dumb the doctor would think I am when I miss important details about the patient or I fall stupidly far behind.  I managed to come out alive, and honestly, when you are thrown into your first solo shift in the ER you find that you are actually capable of getting everything done without a trainer.  That being said, it was still a rough day.

As soon as I arrive at the ER, patients begin pouring in.  Within the first hour, the doctor and I see about 9 patients.  We see these patients back-to-back, which means I don’t get to sit down and start charting the first one until the rush is done. 

I did my best to chart the patients while moving around, but I am still new and that kind of technique takes time to develop.  Needless to say, I was behind on charts trying to catch up the entire shift, and I mean literally the entire shift.  I spent 10 hours doing nothing but frantically trying to catch up.  I think I took one bathroom break and that’s it. 

I knew scribing would be a challenge, and now I really know to what degree that challenge is.  There is a light at the end of the tunnel though — scribing is all about learning how to think like a doctor and learning how to quickly navigate the dreaded EHR.  Once you develop these skills, life in the ER will become much easier.

Further Reading: 5 Important Medical Scribing Tips to Help You Improve

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