A small, rural ER. I have to admit I think this is pretty cool for my first overnight ER shift as an MS4: - Little old lady who was in sustained V-tach, wide awake, talking, complained only of chest discomfort. Not SVT... I mean 12-lead-confirmed, monophasic V-tach. Symptoms appeared an hour before she showed up and she remained in stable V-tach (if such a thing exists) her whole few hours in our ER. The cardiologist on the phone flat out refused to believe it and told us to push adenosine. Of course it did nothing. She also laughed off the amio drip. Sent via EMS to a tertiary care center, in the same rhythm... I heard she arrived in stable condition, still in V-tach. I suggested electricity but my attending balked. "She's sitting right there talking to us!" - Intermittent claudication guy who couldn't believe why the idiot med student asked if he smoked. What did that have to do with his foot pain? (Pack-and-a-half a day.) - Guy whose feet stank so much he decided to clean them with bleach. It works on clothes, right? He may qualify for the "Things I Learn From My Patients" file. - Fifth disease... not so exciting but I diagnosed it the second the kid came through the door. Pretty cool for a dumb med student - Kid with maybe-so, maybe-no r/o appy. Slapping his foot produced nothing, but I know how hard those things can be to diagnose. I still give it a 50/50 chance he comes back tomorrow. And all this before midnight! Exciting stuff. Now I know why the regulars here say "ER burnout" is a myth. P.S. anyone here see stable, wide-awake V-tach for longer than 4 hours?