Common Sense

Thanks for Saving My Life. Sorry I was an A--hole

Issue: September/October 2022

Author: Andrew Mayer, MD FAAEM

Recently, I have had some time to reflect on emergency medicine and my 30 plus year career. I have to admit that this last winter was hard. Taking care of Covid patient after Covid patient and listening to every opinion about vaccines and treatment led me to my worst level of burnout of my career. It is hard really to say why Omicron in particular was hard on me. Of course, my hospital was overwhelmed with cases of Covid but it was not anything like the original wave or Delta. Like everyone else we had huge amounts of boarding and swarms of agency nurses. I think the issue for me was that everyone including myself was just tired. I saw members of my group and the hospital staff have moments when a small obstacle seemed to be their tipping point causing an outburst or atypical reaction to the specific stressor. These reactions were easily recognizable as a product of the chronic stress of working through Covid. This all caused me to look back and think about why I went into emergency medicine and what still makes it the career I would still chose if I had to do over again.

Remember that as an emergency physician you get to do cool stuff. No matter where you work or what the administrative, pay, or nursing situation is right now you still get to do really wonderful things. Many cases which are run of the mill for us would quickly overwhelm many other physicians. Our skill set is impressive and was not gained easily. You need to remember this fact before you walk into the room of the next 90-year-old weak old lady with the 70-year-old daughter who wants you to make her better. You may not expect much in the way of career satisfaction from this case but there are so many opportunities to make a difference in any emergency department. We just need to remember to look for them and reflect and cherish them when they do come along. This will help make the weak and dizzy cases more bearable.

What is your favorite case? Think of the case which makes you smile. My personal favorite case in all of medicine is the Nursemaid’s elbow. This case to me brings bedside clinical medicine to a level of perfection. There is nothing more satisfying to me than this simple case. Remember the times you have walked into that room with the crying toddler being held by the very concerned mother who is sure that their child’s arm is broken. The mother looks at you with alarm when their child whimpers more loudly when you reduce the subluxation feeling that very gratifying pop. You can use your best self-assured doctor lines that everything will be fine and that the child will be playing in minutes as if nothing happened. The look of disbelief from the mother that quickly turns to gratitude when five minutes later she comes out the room stating that “yes, my baby is playing with the car keys just like you said” is priceless to me. No tests or no prolonged anything except fixing a problem that needed fixing. That mother will always remember that interaction.

Your best case ever could be a complex trauma resuscitation, quickly defibrillating the patient whose eyes rolled back in front of you, fixing that complex lip laceration, or whatever. Be honest with yourself when considering this idea. Each of us has a procedure we love to do or a diagnosis we love to make. Please just think about what that case is for you and remember the joy you feel when your training, skills, and experience makes a difference in another human being’s life and the satisfaction you feel from it. 

These feelings of satisfaction can come from less obvious situations. Connecting with a family of a dying patient and talking them through the DNR process can change the way a family remembers their loved one. You’re helping to create a situation where your patient can die peacefully with their family standing and praying around them instead of the horrible memory of a prolonged and difficult death in an ICU has real meaning. Take the win whenever and wherever you can and realize that the things you do actually matter more often than you may think. Don’t focus on the chronic pain patient or the violent patient that tried to suck part of your soul right from your body. Try and fight back by focusing on the good which you do and not the difficult or problematic patients which can get you down if you do not fight back.

What do you do on your way home from a shift? We often become side tracked with life and the phone calls and plans we need to focus on when we walk out of the back door of the hospital. Maybe you should just take a minute to run through the cases you had on that shift and look for the gems that you did not notice or appreciate at the time. These may not be obvious to us as emergency physicians. Remember that several of the patients and their families will remember their “ER” visit you had with them that day for the rest of their lives. Johnny will remember the day he broke his arm as a teenager and hopefully the nice doctor who comforted them while reducing and splinting their wrist. A middle-aged wife will remember that you were thorough and decided to take another look and to go a bit further to find the PE, MI, or whatever the diagnosis. Your skill and professionalism changed that family’s history forever. Do not discount this when you are reflecting on your day. It may have been a totally ordinary day for you on that shift but think of the dramatic and life changing events for some of your patients and their families which were among your ordinary list of emergency department patients for that day. That particular day was not ordinary to them and your intelligence, training and kindness changed their lives. 

Often, we all know that our patients do not appreciate our efforts or skill. Few overdoses awaken after the narcan and politely thank the physician and nurse who literally just saved their life. We must accept this part of emergency medicine while knowing that it did and will continue to matter. A recent act of contrition by one of my hospital’s emergency department patients brought this all into focus for me. A floral bouquet arrived with a simple note stating “Thank you for saving my life. Sorry I was an--hole.” Our patients are often not nice or appreciative of our work but sometimes even the most difficult of them appreciate what you did for them. Most of the time, it is really okay when you are not thanked or feel appreciated for your efforts. You probably did not go into emergency medicine for the appreciation expressed by your patients but instead to save lives and help people. We can easily get bogged down by the negative but remember that what you do does matter. Try and own that fact and it will help.

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