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.
Homicide cops, prosecutors and ER personnel have similar senses of humor. The truth is, doc, that it doesn’t hit you where you live because if it did you would be hanging upside down from the chandelier by your toes. However, the truth is, it does get to you somehow. Not to the extent that it would if all of these people were your loved ones. It is necessary to work through some of it. Of course, some of this horror is the reason that some — not all — but a noticeable proportion, end up hating their patients so much.… Read more »
Lin
17 years ago
Truth stated eloquently. Thank you personally and collectively for all you do for so many.
I felt much of this when I was an EMT and I see more now in medical school. I often used to drive through an intersection and see the remnants that no one else could. The skid marks that were now barely visible marked the end to a families life I attended…. No one else knows.
that sounded self-serving. to clarify, you have written, better than i could, what i feel when we have a rash of deaths in our ED. i am so close to it all that i don’t think i appreciate how it grinds me down. thanks again.
Can I just say what a relief to discover someone who basically knows what theyre talking about online. You unquestionably know the way to bring an issue to light and make it essential. Additional men and women should read this and recognize this side of the story. I cant believe youre not far more popular because you certainly have the gift.
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What a touching summary. Thank you so much for capturing the spirit of what we do… I am proud of your good work. Stay strong.
just wow
Homicide cops, prosecutors and ER personnel have similar senses of humor. The truth is, doc, that it doesn’t hit you where you live because if it did you would be hanging upside down from the chandelier by your toes. However, the truth is, it does get to you somehow. Not to the extent that it would if all of these people were your loved ones. It is necessary to work through some of it. Of course, some of this horror is the reason that some — not all — but a noticeable proportion, end up hating their patients so much.… Read more »
Truth stated eloquently. Thank you personally and collectively for all you do for so many.
I felt much of this when I was an EMT and I see more now in medical school. I often used to drive through an intersection and see the remnants that no one else could. The skid marks that were now barely visible marked the end to a families life I attended…. No one else knows.
we could be twins. keep writing please.
that sounded self-serving. to clarify, you have written, better than i could, what i feel when we have a rash of deaths in our ED. i am so close to it all that i don’t think i appreciate how it grinds me down. thanks again.
Can I just say what a relief to discover someone who basically knows what theyre talking about online. You unquestionably know the way to bring an issue to light and make it essential. Additional men and women should read this and recognize this side of the story. I cant believe youre not far more popular because you certainly have the gift.