Jacob Lentz attended the David Geffen School of Medicine at UCLA. He is in his first year at UCLA Emergency Medicine Residency Class of 2019. Prior to medical school, Jake worked as a comedy writer for the Jimmy Kimmel Live Show for 8 and a half years. Here at Pondering EM, Jake blogs about his journey through EM residency.

My Time in PICU

I finished in the pediatric intensive care unit two days ago. It was a very challenging, very tiring, and very educational experience. By some estimations UCLA has the highest acuity PICU in the United States, and the complexity and challenge of the patients and the illnesses seemed to suggest that this is certainly at least a possibility. It was an exhausting two weeks of fourteen hour work days, most of it on our feet. But the patients, who were invariably cute and quite endearing, made it feel OK to be out of bed at four in the morning.

The first year of residency in the States is called an internship, so while I am a resident (a registrar, as Robbie would put it), I am for this year an intern. During intern year, about half our time is spent in the emergency department and about half on ‘off-service’ rotations – PICU, MICU, CCU, Trauma, Plastics, and so on. Part of our time with the other services no doubt includes some aspect of cheap labor, but the program is well-designed, and I’ve resolved to embrace all the off-service rotations as opportunities to learn and to get to know my colleagues in the other specialties. And also to spy: I’m learning how they think, what words get them excited on the phone at two o’clock in the morning, how they like their patients to be worked up when they get them from the emergency department. It’s all tremendously valuable.

Pediatrics, like emergency medicine, is an oft-mocked specialty inside the house of medicine, but I found the pediatric residents, fellows, and attending to be incredibly knowledgeable, competent, and compassionate. Also a pleasant discovery – they’re funny. Not just good-natured and easily amused – truly clever and funny and ironic. Luckily I did not do my pediatrics rotation with these people, or I may have ended up a pediatric intensivist.

It was also the first time that I experienced a dread of all residents here, ‘hammer paging.’ This occurs when the nurse for each of your five or so patients pages you – bleeps you, I think they say in the UK – to tell, ask, or remind you of something. Doing anything for ten minutes straight without a loud page breaking your concentration was nearly impossible. But that is the job, and keeping everything straight and moving along is a skill any emergency physician needs to develop, preferably sooner rather than later. I finally got note cards to write down everything people wanted from me so as not to lose track and to free up a bit of mental bandwidth as I go.

I am now back on emergency medicine at a government-funded hospital in Los Angeles (one of the hospitals where we work in our program). If nothing else, I’m glad that nobody is asking me how to calculate TPN orders. I did my first good thing as an emergency doctor by not discharging a man with an apparent URI yesterday.

Until next time!