The end is the beginning (again)

I feel a little bit like my childhood had just ended.

Sitting cramped in the middle section of a jumbo jet, I can't quite believe it is over. Three years after the final screening, I finally got around to watching the final season of ER.

ER is the show that, as a nine-year old, Dad allowed me to stay up late to watch. It was our little thing - Thursday nights with ER and no reading time (because otherwise I'd be up way past my bed time). The shows were peppered with commentary from Dad - the hospital wasn't really in that part of town and there was no way the characters could have gotten from A to B in that short a time period. Sometimes, during the ad-breaks, I would listen to Dad's stories of the city's past and wonder...is it really like that? It was a time where my mind was opened up to a whole new way of thinking. I distinctly remember sitting in the car on the way to school and asking Dad about the show. If, for some reason, I didn't manage to watch an episode, I would want to hear every last detail. And if I had watched it, I would want to know more. Although I knew it was just a TV show, ER was always a real and tangible part of my world.

Fast-forward all the way to May of this year and I was wandering the streets of Chicago, seeing sights I remembered all too well from the show and feeling somewhat like I was walking through history. I knew, somewhere in the back of my mind, that Cook Country General Hospital wasn't in the sort of area to which I would just wander over. Still, I really wanted to know if the Emergency was really as exciting as it is portrayed on television. Are there really multiple traumas from explosions, gun fights and stabbings? Are there really such diverse presentations? Are there really that many surgical consults and operations performed in non-sterile conditions?

My experience thus far would suggest the answer is no. I've had the honour of spending some of my training this year in the Accident & Emergency at my hospital. The first time I walked into the department, I had been expecting all sorts of commotion - teams working quickly, strategically and in perfect harmony to save lives. It was quite a surprise, then, to walk into a relatively quiet area, with quiet hums of health professionals talking to patients about their procedures and the possibility of transfer onto the wards. There was no commotion. There was no running though some of the staff walked very purposefully. And there was most definitely never any broken hygiene protocol.

Watching this final season of ER has been a lesson, often, in what not to do. Don't yell at your colleagues. Don't try to work with no sleep. Don't drink the bad coffee in the cafeteria. Don't give patients medication without consent. Don't date your fellow staff members. Do take a breather when you need it. Do seek advice before doing anything drastic. My medical-student mind often wondered why the doctors in ER explained so little of the procedure to their patients, and why so many social conversations happened over the heads of conscious but ill people. Sometimes I found myself wanting to ask the doctors why they had prescribed this drug over that one (County is, after all, a teaching hospital). Often, I found myself mentally shouting at them to put on gloves, or go scrub, or wait until the alcohol had dried before inserting a needle, or to ask the patient to stop speaking for a moment while they listened to the chest. Because anyone who's ever tried to listen to a chest of a speaking person will know that it's altogether too loud for one's ears to handle.

Still, seeing the heroic (if unlikely) efforts of the County General team, who give their all every moment of every shift, inspired me. Perhaps, retrospectively, I could say that my attachment to ER was part of what drove me to study medicine, though the real reasons are far more complex than that. Perhaps one could suggest that is why I pondered emergency medicine for a short time - to be in Emergency, you have to be an excellent diagnostician, you need to know what to ask and what to do right now.

Watching this final season has been watching the end of this particular phase in my life and my training. I have now, for the most part, finished the basic clinical science, lecture-based learning portion of my degree. From now on, I will spend my time in hospitals and clinics. From now on, there will be few cushy three-hour lecture days and afternoons to spend in the sunshine. We leave behind much of our 300-strong cohort for our individual clinical schools and say goodbye to the socialisation facilitated by breaks between lectures. We are back at the bottom of the pecking order, where our knowledge is almost never good enough and the things we need to know seem overwhelming. We know enough to know that we know almost nothing. Just like Grady, an intern on ER, said, "even when you know you know something, you'll still say it with an inflection." You second-guess everything, even when your first guess is much closer to the mark. And you hope like nothing else that you'll know enough when the time comes.

This is the end of an era.  The end of the childhood safety of the classroom. But it is also the beginning of something bigger. Something more amazing and humbling and intense.

And only one thing's certain. County's in my blood.

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