The Emergency Department is an intriguing place. It is truly a world of its own within the larger hospital facility and healthcare system. For one thing, it is fast-paced medicine like you've never seen it. In that sense, it's no wonder Emergency Medicine attracts the "daredevil" doctors who are always seeking new thrills and adventures. It is easy to get a rush from the adrenaline that comes from saving the life of a patient who is eminently crashing, or from being the first person to diagnose a life-threatening condition presenting in the ED with an acute symptom.

Of course, it's not all the excitement it's cracked up to be, either. Working in the Pediatric Emergency Department the past few weeks has taught me one thing: There are a lot of overanxious parents out there.

Many of our patients have absolutely nothing wrong with them that a little time and ibuprofen can't cure. It's befuddling to see worried parents drag their two-year-old child out of bed and bring him to the ED at 2:00 in the morning for a fever or a slight cough that has been going on for several days. What finally drives them to seek care at this particular moment rather than see their primary care physician during regular office hours? Panic. Just knowing that a resource isn't available creates a feeling of desparation that leads to overreaction. But what do they expect us to say in response to their concerns that Little Joey isn't acting as energetic as he normally does? Well, for one thing, it's 2am and he should be sleeping. I'd be crabby or lethargic, too, if I were in his shoes. In this regard, I'd say one of the most important roles of the Emergency Medicine physician is to reassure parents that their child is not dying from the new rash that has just cropped up in his diaper area, or that they don't need extensive radiation exposure and blood testing to discover the reason Molly cried for an hour straight the previous night.

There are, unfortunately, some parents who are so uptight and controlling that they would rather create more discomfort and pain for their children by insisting on invasive procedures, just so they can have peace of mind that there is not something wrong with their child, however unlikely. These situations are most frustrating. There is the mother who refuses to leave until her baby gets a lumbar puncture, even though the cause of fever has already been discovered. There is the father who insists that we re-open the already scabbed over lip laceration of his terrified 5-year-old son, just to see how gaping the wound really is to see if suturing would be a better option than the scab that is already doing the work that a painful stitch would do. There is the parent who is determined not to disrupt her holistic ideals of anti-medicine/anti-vaccines, thus not allowing her 11-year-old child to have anything stronger than Tylenol while orthopedic surgeons reduce a severe buckle fracture of the arm. Consider the irony when she later admits to having had general anesthesia herself when she had her wisdom teeth pulled...a far less painful procedure than having your bones reset. As much as we try to maintain our autonomy and do what is best for the child, there are some situations where we simply have to comply with the parent's wishes, not only for legal purposes, but also to avoid the sure-to-come repeated ED visits that will continue until they get what they want.

The most entertaining patients encountered in the Emergency Department are those who present with foreign bodies or other accidents. There is the 3-year-old with pierced ears who has an earring post completely embedded inside her earlobe with skin overgrown. The 5-year-old with a dead bug in her ear canal. The 18-year-old who burned his hand lighting a kerosene fire at a High School Senior party 3 days earlier. The 12-year-old who stepped on a ceramic dogfood dish, resulting in a nearly complete severation of his foot. It's always fun asking for details surrounding these events.

Working in the Emergency Department does have it's high points. I haven't yet found a more satisfying experience since starting residency than when a 2-year-old comes in with immense pain, refusing to move her arm, and I correct her nursemaid's elbow with a quick and easy maneuver, feeling the "pop" of the ligament moving back into place. There is also the satisfaction of providing care for someone who hasn't been taken seriously in the past. The other day, we had a 17-year-old boy come in with high fevers, chills, confusion, and pain in his wrist and shoulder, unrelated to any trauma. He had seen his primary care physician twice that week and both times had been dismissed with an upper respiratory infection. Even though I'm just an intern and don't know much, I knew enough to recognize that this kid was SICK. Within an hour, we admitted him directly to the Pediatric Intensive Care Unit for a brain abscess. Come to find out, he had been hit in the face with a basketball the previous week and had a major septal hematoma with septic emboli invading his joints. There was also the 4-year-old girl who came in with fevers up to 107.5 degrees Fahrenheit who turned out to have an impressive right middle lobe pneumonia. We were able to start her on the appropriate IV antibiotics that night and eventually sent her home with her very grateful family.

The spectrum of pathology seen in the Emergency Department is stimulating. Being able to reassure parents, as well as comfort and treat patients for anything from ear pain and fevers to sprained ankles, respiratory distress, or seizures during one nine-hour shift provides all the intrinsic satisfaction for which most of us decided to practice medicine in the first place.