Monday, October 9th, 2017

Learning as a Medical Scribe

Lelani Lealiiee

Standing in the trauma bay waiting for the next patient, I remember the first time I actually gave myself a pat on the back for all the scribing I’d done. “What lab would you order as a simple test to tell if the patient could have, in fact, had a seizure,” the fellow asked the medical student in front of me. She ventured several guesses, but unfortunately was wrong. All I could think in my head was, “lactate! Say lactate!” Eventually she gave up, and when the fellow said, “it’s a lactate,” I was so excited I don’t even remember hearing him giving her an explanation.

It all started while I was bussing tables, taking orders, and running food, from 3:00pm to 2:00am. I loved talking and connecting with my tables, but still felt that job wasn’t enough for what I wanted to do long term. I wanted to learn, I wanted to engage and dive into the medical field before I was a doctor.

As luck would have it, one night I was serving a woman sitting in a large booth. She was by herself but waiting for her wife and two children. I brought her two tablets for when her children came and a trivia question popped up on the TV screen. “What medication is used to induce labor?” Easy! I said, and she said yes, oxytocin. Immediately, I asked if she was in the medical field and found out that she was a doctor. We discussed our paths and how I loved my job, but really craved more medical exposure. This was when I found out about medical scribing, the exposure it offered, as well as other great benefits. That night I sat down and applied to every single open scribing position in my area.

Three months later on my first shift alone, I remember running into a room for a “code blue”. I recall charting every medication push, every chest compression, pulse check, and shock with the AED (automated external defibrillator). Oh yeah, I thought after walking out of my shift. This job is it! The exposure and potential to learn does not get better than this. Adrenaline was still pumping through my system.

Working as a scribe in the emergency department has taught me more than I even knew I wanted to know. As a scribe, I’m essentially shadowing physicians and doing all charting for them. I run to every code; I am there for every trauma, every critical patient, and I see the compassionate looks in a doctor’s face when there is no bringing a patient back and they must break that news to the family members. I work at a level II trauma center , and essentially, I get taught like a medical student. I can ask all the questions I want about labs and imaging, why the doctors ordered them, and what on the physical examination validated the order.

Going into scribing, I was scared. What if I can’t type fast enough? What if I miss part of the physical exam? Or forgot to tell the provider that imaging or a pertinent lab is back and abnormal? The best thing is they understand, they know you have not gone to medical school, and they know you are eager to learn. I always tell new scribes that if they have time and the provider is not busy, ask that question. Just go for it. They love to teach! I’ve learned to look at CT’s and X-rays, and ultrasounds and understand the different organs they’re studying and why they are interested in that exact one. I have learned about cardiac enzymes, such as troponin, and why an elevated troponin accompanied by chest pain can determine a heart attack. I’ve seen more than I could have imagined in the emergency department, and it’s incredible.

Before scribing I wanted to be an orthopedic surgeon. I observed one orthopedic surgery and was in awe, almost determined that that was what I wanted to do, until I felt the adrenaline of my first critical trauma patient. I remember watching the female trauma surgeon simultaneously own the room and cohesively work with the team. It was astounding; I loved the coordination between the emergency doctor, the nurses, and the trauma team. All I could do was stare in admiration as the unified team worked. The excitement pumped through my veins as my hand was writing faster than I even knew possible. I attempted to chart all of the physical exam being called out by the trauma surgeon and the emergency doctor, all while backtracking and ensuring I caught any medications they were using. Multiple traumas later I decided that was what I wanted to do. The rush is indescribable, and if there are critical patients, I want to give them more time with their loved ones.

I really cannot put into words how valuable my medical scribing experience has been and how and how much it’s preparing me for medical school. I’ve learned that it is okay to not know, and to be curious, and questions. Learning doesn’t always come from endless amounts of reading and drilling yourself over what a cytokine is. I mean, how else can you know how to read an electrocardiogram (EKG), or a CT, or know about labs and abnormalities without asking?! The art of medicine is also understanding the art of not knowing. Medicine is always changing, ever-expanding, and there is always something one can learn. I hope that while I continue my pursuit in medicine I will carry these lessons that I have learned through scribing, and eventually, am able to mentor and teach others just as eager as I am.

About Lelani Lealiiee

Lelani is from Torrance, California and currently attends Portland State University as a science major, chemistry minor. She is a research intern in the trauma lab at Oregon Health and Sciences University and homeschools her 6-year old son. In her free time enjoys baking, watching her son play sports, and Polynesian dancing.

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