The things I do….
"Why am I doing this?" I thought to myself as the vomit exploded from the boarded drunk patient and missed my non-existent protective clothing to cover me in foul smelling remains of last night's dinner mixed with ample alcohol. I would not be covered at all but I was rolling him, hopefully not in a vain attempt, to prevent him from aspirating. Unfortunately, this was not the first bad experience this week. Recently, a trauma patient attempted to punch me, a surgical consult suggested I go back to medical school, and one of my coworkers came up to me and said, "Remember that woman you saw with abdominal pain last week, well she is a lawyer…"
Later as I reflected on my chosen career path my feelings were mixed. Out of all the opportunities in medicine why did I choose the one that subjected me to so much abuse? I had never been a masochist and while Emergency Medicine provides a good lifestyle there are other specialties with equal or better lifestyle options. The more I pondered, the more I came to understand that in some way I loved being a physician that practiced the specialty of Emergency Medicine. Love is the only explanation sufficient to justify the late nights, the overnights, the weekends and the holidays. Only love gives you that warm sense of anticipation every time you walk in the door. Only love stands the test of time and heartache when all is not as well as you would like it to be. And only love allows the whole human experience to be enjoyed and savored. There is very little that compares to walking out the door at the end of a shift knowing that you have played an intimate and beneficial role in the continually unfolding human drama that exists in the emergency department.
I think falling in love is not hard. It seems to happen to humans all the time. We fall in love with each other, with our homes, our pets, our cars, and sometimes even our jobs. I needed a job I could love. As I got older nothing was more painful than thinking about going to work every day and doing something I did not love to do. I do not remember the exact moment I realized I had fallen in love with emergency medicine. For me it was not love at first sight but a gradual realization that it was right for me.
My first real exposure to my chosen specialty was as a volunteer during college. The emergency department was in a small college town and the doctor and I were fly fishing friends. It was very slow. One night I was manning the EMS radio, the doctor was getting something to eat while the nurse was out in triage. A call came in stating that EMS One was bringing in a 45 year old man "shot" six times to the chest with an automatic, CPR in progress. I yelled for the nurse who activated the hospital resuscitation team. The doctor soon returned. He did not seem overly anxious given what I thought was a big deal. Soon the EMS squad rolled in performing CPR. There was no blood, no bullet holes, their report stated he was "shocked" 6 times with an automatic defibrillator. I was congratulated on needing a hearing aid and got my first taste of what real emergency medicine was like.
I was relatively aimless as a medical student. I liked every rotation for the first week and enjoyed doing and learning the entire time but during all my required rotations never found that one field that I could imagine doing the rest of my life. My favorite rotation was surgery and I found the operating room fascinating for the first 15 minutes of a case. Apparently this is the limit of my attention span. Finally, during the summer of my 4th year I was doing an anesthesia rotation. I had just finished working on a bowel resection case. After recovery in the PACU, we had extubated the patient and I had taken him back to the ICU. The nurse and I hooked him up to the monitors and noticed he began to have labored breathing and was rapidly becoming hypoxic. I told the nurse to call the anesthesiologist as I placed him on a 100% non-rebreather and positioned his airway. I quickly ran through the differential of what could be causing this sudden deterioration. I had placed a subclavian line in the OR and I knew I had to rule out a pneumothorax and investigated accordingly. While it turned out he did not have a pneumothorax I felt thrilled to have responded so smoothly and so calmly to what seemed like an emergency situation. The nurses told the anesthesiologist they were impressed with how calmly I handled the situation. From that time forward I think I was hooked.
Although falling in love is not hard to do, staying in love and having that love grow is a challenge. It is just a fundamental part of human nature. Once the newness and the excitement wears off the work really begins. I went from medical school and matched in an Emergency Medicine Program that was just perfect for me. Soon I was busy working 12 hour shifts which often turned into 13-14 hours. Everything was new, exciting and scary all at the same time. I distinctly remember just starting a shift about 2 weeks into residency when the chief resident asked me if I wanted to come and intubate a patient. I walked in the room and the patient was sitting up, near breathless, saying over and over, "I am going to die." Not on my watch. I took my lead from the Chief and performed my first rapid sequence intubation. It was smooth and it was beautiful. I felt incredible. I loved the doing part of emergency medicine. Reducing fractures, reading EKGs and radiology studies, intubating, placing central lines, treating myocardial ischemia and pulmonary edema, running trauma resuscitations all made me feel like I was actually making a difference.
On the other hand, the more time I spent in the ED I began to see the downside as well. Trivial visits, administrative work, lectures, conference, abusive patients, difficult consultants and people dying despite my best efforts all led to a degree of disillusionment. And if the work itself is not enough to discourage you the lack of respect sometimes will. Even now I sometimes get the question from both doctors and patients, "So what are you going to specialize in?" The frustration can often be enormous and sometimes you wonder if it is worth it. The cost of love is never cheap. Love always requires a price as does anything else worth having.
Though the costs are great the rewards are greater. As time goes on the rewards deepen. I have come to understand that during the brief period of time a person is in my department, I have the ability, opportunity, and power to have a positive impact during the most stressful of human situations. The emergency department is full of such situations. Often things do not go the way I intend them to. Surprises, heartache, disappointment, and fear are inherent to our unpredictable specialty. Real people often die or are severely ill or injured. Family members expect us to work miracles and I will never get used to the agonizing cries of those who have tragically lost loved ones. However, I have hugged family members when loved ones have died, I have fought consultants to get my patient the right care, and I have seen the light in a child's eye when I let them pretend to be the doctor. Even keeping someone alive long enough for family to come in and say goodbye brings meaning to my work. And sometimes I have been there, and as a result of all the training, experience, and luck, have been able to save a life. Very little compares to the incredible feeling after a good save. Beyond the mere finance of emergency medicine, beyond the headaches of coding and billing, documentation, and malpractice there is a palpable satisfaction that comes from doing something you love and loving something that despite what the cynics say, really has such a deep impact on not only our patients but on ourselves. I am in love, despite the cost, and would not do anything else.