The hospital where I practice is medium sized, in a semi-rural community. We see lots of medical illnesses and a fair amount of trauma. We also face our share of tragedy. But two weeks ago, it seemed like the death angel was hovering overhead, with no other place to be. A kind of surprise vacation stop for him (or her).

In the course of two weeks, we had a SIDS death, a drowned 19-month-old, numerous multi-traumas, a young man die from fulminant meningococcal sepsis (two hours from door to death), and two high school students killed in the same MVA that left their two friends (also in the car) critically injured.

Those are tough times. I’m always fascinated by the way physicians, nurses, medics, clerks and all the rest cope in emergency departments. I was thinking about the drowned child. We worked that child, resuscitated him, sent him to the children’s hospital, and waited for the news that inevitably came; his ultimate death. And yet, through all of the pain and suffering and loss, we plugged on.

Do you realize, dear brothers and sisters in arms, that most people in our society would crumple to the ground in heartbreaking sobs if they saw 10% of what we see?  That they would immediately go and 1) get drunk, or 2) lie in a fetal position stricken with terror and survivor guilt or 3) begin intense psychotherapy or illicit drugs and 4) consider it one of the most horrible moments of their lives?

And yet, after popping intraosseous lines through the tender bones of children, after putting a chest tube in a screaming
toddler with a tension pneumothorax (as I did last week aftger a cow stepped on the child…that’s rural EM), after telling a family their dear husband/father/mother/daughter/son is suddenly and quite permanently dead, after all this…we keep on going.

We move to the next patient, and focus on the next complaint (which often seems comically trivial by comparison).  We treat the ridiculous things with dignity and professionalism.  We fill out work excuses and prescriptions as the images of cyanotic, broken bodies find their way to the filing cabinets of our minds.

What I’m saying is, in the mix of death and mayhem, of bad news and bad outcomes, we rise to the occasion like gray-winged, blood tipped, angels; fallen, but not quite all the way.  We drop ourselves into the crushing pain of the lives that come to us, and we keep doing it.  Brothers and sisters, this is amazing, and heroic.

Some of us probably develop PTSD, or at least a little of it, that lasts for our entire careers.  Yet we come back.  Some of us struggle with depression; I struggle with anxiety sometimes, from seeing so many bad things that happen rarely, and still extrapolating them to the daily lives of my wife and children.  Some physicians drink and drug and change partners and do all of the things they think will ease the pain.

The problem is, for all our narcotics and sedatives, our pain scales and our facility at finding the source of suffering, we seldom embrace our own.  But at some point, the best thing we can do is turn to it, turn to all of the memories of all the bad things on bad days, and say how much it hurt to see, how much it hurt to absorb the suffering that smothered every resuscitation room and every family conference room like a thick, toxic fog.

If we accept that it was hard, and that it is hard, we’ll be happier for the honesty.  And we’ll see just how proud we should be of the very difficult job we do, day and day out, night after night, in a sometimes terrible place in which we are always moments away from someone else’s tragedy.

God bless you and keep you,


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