ER top 5: a few thoughts on why I (generally) love my job

Humanity

CJEM 2008;10(4):396-397

I am an emergency physician. It's been 10 years since I completed my residency and skipped off into the big wide world where my name is the one marked "attending physician" on the ER chart. This 10-year marker apparently qualifies me as an "expert" (medical educators use this benchmark to assign expert status — apparently you've seen enough to be smart about what's going on, but haven't yet forgotten enough to be behind the times). Further reflection forces me to admit that comments I used to dread, like being asked if I was old enough to be a doctor, or if I'd ever done the procedure before that I was preparing to do, have disappeared — and now I miss them. I suppose if you're going to be an expert, you may as well look the part!

Since I am beginning the peak of my career, I felt it was time for some reflection. People are always asking me if I like my job, and occasionally make comments like "it really takes a special person to do what you do" — a kind of backhanded compliment that suggests I might be some sort of sadist who enjoys blood, gore and emotional distress. After some contemplation, and even in the face of extensive publicity on the sorry state of overcrowding in our nation's ERs, I have to say that yes, I do like my job. Very much, in fact. And as an answer to all those people who ask me what it's like to work in an ER, and for the medical students who are contemplating emergency medicine as a career, I've prepared my own list of the top 5 reasons why I love being an ER doc.

Number 5. The colleagues

Emergency doctors are great people. Just like that baby bird that wanders around looking for his mother after he falls out of the nest (he tries to bond with dogs, cats and eventually a steam shovel before he finds his mother)1 I wandered through medical school looking for a group of people with whom I felt at home. When I first spent some time in the ER, I found this energetic group of doctors — all with great communication skills and hobbies outside the all-consuming world of medicine. Emergency medicine is overstocked with family-oriented, athletically active people. The overwhelming majority of ER doctors I know are committed to maintaining a balance between work and play, and most of them have a fabulous sense of humour.

Number 4. The team

Nowhere in the hospital is the multidisciplinary nature of medical care more pronounced than in the ER. Nurses, respiratory therapists, paramedics, firefighters, police and a whole host of others gather in the ER to routinely provide care or support to patients with various medical problems. It is hard to describe the pleasure to be gained from watching or coordinating a large group of people seamlessly working together during a critical resuscitation. Plus, my kids think its cool that the paramedics wave to me from their ambulances.

Number 3. The variety

Jack-of-all-trades — that's the ER doctor in a nutshell. From lacerations to heart attacks, appendicitis to jock itch, we see it all. And it is really interesting not to know what's going to happen while you're at work. Some people hate this — the lack of control, the constant interruptions and the inherent uncertainty of what we do. But for those of us who have very short attention spans, it is precisely that variety that keeps us entertained and still able to get up at 11 pm for a long night of work.

Number 2. The cool equipment

There are a ton of machines that go ping in the ER, and a lot of them are really neat. As someone who was never attracted to video games, it may seem odd to be fascinated by electronic devices. Emergency medicine is expanding as a specialty (despite my mother's friends who still ask me when I'll be finished with that emergency stuff and heading into real medicine) and the incorporation of ever more versatile equipment just adds to the enjoyment. We're using our own ultrasound machines to speed up the diagnostic process and to help us do things we used to do blindly. Advanced robotic simulators are taking the place of good old Resusci Anne (Laerdal Medical) for teaching, and things like video laryngoscopes are just plain fun to use.

Number 1. Making a difference

It does sound hokey, I know, but the biggest bang from this job is the sense of satisfaction you get from helping people out. Nothing is better than seeing an 8-year-old with a badly broken arm, sedating her and straightening it out. The biggest problem with ER overcrowding is that it interferes with your ability to do the things that make your job worthwhile. Or to do your job at all. The bloom is off the rose if the 8-year-old had to wait 6 hours on a stretcher in the hall before you could do your thing because the place was packed full of admitted patients occupying all the ER beds. When our ER is reduced to 3 free stretchers, it's our patients who wait longer and longer to be seen and treated, and it's hard to justify spending an extra 2 minutes with someone making sure they understand you when your waiting room is 5 hours behind. Even faced with such conditions, the best part of the job is still the chance to fix something or solve something, or even to reassure someone about his or her symptoms. It's why I go to work every day.

I hope that the administrators and health care policy wonks can make some strides changing this climate of overcrowding, so that I can get back to loving what I am doing and preaching the gospel of emergency medicine to whomever wants to listen. As a self-acknowledged expert, it's the least I can do.

Reference

1. Eastman PD. Are you my mother? New York (NY): Random House; 1998.