On Language And Swallowing Pride In The Emergency Department

Since September I have been working as a scribe in a couple of emergency rooms, working 40 hours a week, and paired with a physician each day. My goal is to capture the patients "HPI", or history of present illness, in a way that is medically relevant (and also relevant for billing). For each patient that presents to the ER, I follow the physician's process, step by step, from introduction, to ordering labs and imaging, to the various consultations he or she may call upon until the patient is either feeling well enough to go home, or they are admitted to the hospital for further evaluation. When it's all said and done, my final product should show a complete history of what brought the patient to the hospital, what was done to help them, and when exactly everything happened.

I spent the first couple of months in what I refer to as "treading underwater", as I struggled to learn the dialect of physicians and nurses from scratch, a language that they have spent many years and hundreds of thousands of academic dollars learning. Being at work often reminded me of the year I spent in Norway, having been introduced to a brand new language, armed only with ambition, humility, and a strong desire to know what the hell was going on. Here in the hospital, I felt the same way (and still do at times), and struggle with the elaborately precise diction that can, at times, can seem ridiculous.

As a new scribe, there was nothing more terrifying than calling the "dictation line". Whenever a patient gets and X-ray, CT scan, MRI, or other type of imaging, it is sent electronically to the radiologist who reads the film and then dictates their interpretation onto the phone database. As a scribe, it is our job to see a) when the images are ready, b) call and listen to the radiologists interpretation, and c) relay that information to the physician. A simple process. But simple does not always mean easy, especially when the interpretations of images are riddled with terminology that you have never been exposed to. Now throw in a radiologist at the end of their shift who is reading as fast as possible. Still too easy? Maybe you get one that is so overwhelmingly complicated that it's about as long as this paragraph. So I ended up with my ear to the phone hitting the "3" button time after time (rewind), listening with every potentially-recruitable brain neuron for some clue as to where one word is ending, and another word could be starting (or maybe it's just one long word?). At times it seems like an evil game of Apples to Apples.  And throughout this whole ordeal, if the physician needs to go to the next room, you stop where you are, save what you have, and try again when you have free time.

But, like the rest of the job, the terminology comes to those who are persistent, and all of us are (we have to be). The process of learning can be difficult and stressful, which is compounded by working with physicians who expect the absolute best out of themselves, and through the scribe's role as the physician's "literary representation", the best from us as well. To me, there is nothing more disheartening than being given a task and falling short of expectations, and it's hard to come to grips with my inevitable shortcomings through this process. I hardly go home after a shift and feel as though I did really well, but at best I feel as though I survived.

However, this is the natural process of head-first learning. This is being thrown into the deep end of the pool. I am finding that there is a fine line between accepting  my limitations and yearning for perfection. I will always make mistakes, and there will always be somebody out there who is better, faster, or smarter, and sometimes that's a hard pill to swallow. Perspective needs to be maintained in moments like this, when the pressure builds, and the patients keep coming in, and that creeping sense of overwhelmed confusion starts to tip-toe around the corner. I suppose the mindset needs to be "Do your best at the time, and if your best isn't good enough for you, then find a way to make it better later".

In terms of the language of medicine, I've learned that I need to be patient with the learning curve. Either actively or passively, the terminology is going to root itself in my vernacular. And I have learned that pride is overrated in the ER. If you don't know something, ask.