‘Gunshot wound to chest, pulseless, 20 minute ETA.’ When that’s the EMS report, it gets your attention. Despite the wonderful theatrics of modern medical shows, and the best efforts of real-world, sweat-drenched paramedics, those of us who have done this long enough can translate that report. For the layperson it means: ‘Dead.’
I saw that last week. And the week before I saw another tragic, unexpected death in a man not much older than me.
Twice I walked into a small room and looked into someone’s face and said, ‘I’m sorry, but he died.’ Twice there was weeping and moaning, and a woman sliding to the side of the chair as someone else tried to hold her up. A woman suddenly contemplating life without a person of inestimable value to her happiness.
I have this theory, and I think I have written about it before. But here it is again for the new visitor or the returning friend and reader:
Send a young man or woman in the armed forces to Iraq or Afghanistan. They’re in country for a year. They see combat. Terrible things. Or they don’t, but they see the consequences; victims of IED’s, for instance, that they have to care for. When they return, if they come to our emergency department and say, ‘I have PTSD,’ we say, ‘I understand.’ We believe them. And why not? Who are we, who am I, to say what event or set of events is sufficient to cause nightmares, anxiety, horrible memories, paralyzing fear?
Send a physician to an emergency department for 10 years, 20 years. And while we admit that it’s difficult to care for the dying, the broken, the shattered; while we admit that it’s horrible to give ‘the news,’ we just press on. After all, we get paid well, right? And to admit the emotional consequences seems a little weak, doesn’t it? I mean, we can power through can’t we? It was only a dead child, it’s only a hallway full of grief, it’s only self-reflection and wondering what else we could have done! There are patients to see. It’s only 2 am, or 2 pm. There are five or eight or 12 more hours to go!
So, we ‘burn out.’ ‘I can’t do this anymore, it’s the administrators! It’s the EMR! It’s the falling revenue or it’s the drug seekers or the shift work or the patient satisfaction…’ or any number of very real reasons to be frustrated and reconsider life.
But maybe, just maybe, it’s drinking 200 proof pain and suffering for a very long time. What’s the toxic threshold? What’s the number of death notifications before half of us want to quit?
I’m not ready to quit. But I’m not bragging, just stating. I have some years left. At least for now. But what if you don’t? What if you’re done with seeing deaths from car crashes and violence and new cancers and aneurysms and pulmonary emboli and all of those life-changing things?
My theory is just this; maybe what we call burnout is our own PTSD. Our own brain saying, ‘enough.’ And it applies to more than physicians. It absolutely applies to nurses, and to PA’s and nurse practitioners. It goes for police officers, who are often the first to see the lifeless or dying form in the savaged car, or the bloody floor of a hotel or bar. It goes for the first responders, paramedics and fire-fighters who jump into the fray fearlessly trying to snatch life from death. They ‘burn out’ too.
If so, it’s OK. To everyone who sees and intervenes in life and death situations, I say ‘ you’ve done more good than you can ever imagine. And if you tell me it hurts too much to go back, then there’s no shame.’
Edwin – You share a front-line but often ignored truth. Some suggest doctors, nurses, EMS, and other caregivers “get used to tragedy” – I think otherwise. The devastating events we experience affect us in ways obvious or otherwise. The emotional onslaught in the ER is intense and cruel. The special, caring people that do so much for others are vulnerable (nurses were not noted in what you keenly identify is a long list of those at risk) to the damage the daily tragedies leave in its wake. I appreciate your candor in sharing this important message. Caregivers have long ignored… Read more »
Tom, thanks for the reminder! I’m going to make the addition now. I appreciate the encouragement my friend. Have a great day!
Mike
9 years ago
Edwin,
I’m a med student/former paramedic considering EM. What do emergency docs do when they’re done with the pain and suffering of the ER, but they still want to work in medicine?
Good question! Sometimes they move over into urgent care. Many do administrative work (local or regional ED directors or even hospital chief of staff, etc.), or have been in academics all along, and can reduce their clinical exposure to make it more bearable. Some do occupational medicine, or those who are fellowship trained may simply do full-time EMS, Aeromedical, toxicology, ICU, sports medicine, hyperbarics, etc. I suggest docs go to smaller, slower ED’s where their skills are important but the volume isn’t as daunting. I hope that helps!
Dr. G
9 years ago
Great piece. I appreciate the insight. Having worked EMS for several years, and having been a military physician for a relatively short time, I can honestly say that there is little difference in the types of injuries seen on the battle field and in busy metropolitan areas. Sure there are different injury patterns (higher incidence of penetrating trauma and blast injuries in the military population) but I assure you that the Baltimore Shock Trauma Center TRU is currently taking more casualties of violence than Craig Joint Theater Hospital. There are certain aspects of military medicine that are profoundly different, including… Read more »
Dr. G., thank you for your kind words and for your wisdom. I’ve actually done just what you said, questioning (gently) their experiences then checking online for the units, etc. Recently found one who claimed to be 82nd Airborne but almost certainly couldn’t have been from the story. I never served in any combat theater, or even on active duty, but many years ago was an ANG flight surgeon, so I generally know the right things to ask. Were you there during the surge?
Thank you Tom. It means a lot coming from a mentor.
Dr G
9 years ago
Thank you for the reply and I applaud your efforts. During the Surge, I was still an eager medical student… I have only had the privilege of coming to this conflict during the last gasp, and although things have winded down, it appears to be far from over and I write this from a cold place in the middle east. A mentor of mine sent me your article, probably because she believes I could be the subject of your article. We all go through ups and downs dealing with tragedy differently, and I haven’t been around long enough to say… Read more »
Amanda
9 years ago
Ed, great article. Our medical culture of compassion for each other is quite distorted for a variety of reasons. I hit the burnout three years ago and have been redesigning my personal road map ever since. I arrived to medicine with my own brand of PTSD as I think many do as those who want to serve know what it is like to be in situations where compassion and support are lacking. You might like reading The Body Keeps Score by Bessel Van Der Kolk MD. Five more years of full time and I am done.
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Edwin – You share a front-line but often ignored truth. Some suggest doctors, nurses, EMS, and other caregivers “get used to tragedy” – I think otherwise. The devastating events we experience affect us in ways obvious or otherwise. The emotional onslaught in the ER is intense and cruel. The special, caring people that do so much for others are vulnerable (nurses were not noted in what you keenly identify is a long list of those at risk) to the damage the daily tragedies leave in its wake. I appreciate your candor in sharing this important message. Caregivers have long ignored… Read more »
Tom, thanks for the reminder! I’m going to make the addition now. I appreciate the encouragement my friend. Have a great day!
Edwin,
I’m a med student/former paramedic considering EM. What do emergency docs do when they’re done with the pain and suffering of the ER, but they still want to work in medicine?
Mike,
Good question! Sometimes they move over into urgent care. Many do administrative work (local or regional ED directors or even hospital chief of staff, etc.), or have been in academics all along, and can reduce their clinical exposure to make it more bearable. Some do occupational medicine, or those who are fellowship trained may simply do full-time EMS, Aeromedical, toxicology, ICU, sports medicine, hyperbarics, etc. I suggest docs go to smaller, slower ED’s where their skills are important but the volume isn’t as daunting. I hope that helps!
Great piece. I appreciate the insight. Having worked EMS for several years, and having been a military physician for a relatively short time, I can honestly say that there is little difference in the types of injuries seen on the battle field and in busy metropolitan areas. Sure there are different injury patterns (higher incidence of penetrating trauma and blast injuries in the military population) but I assure you that the Baltimore Shock Trauma Center TRU is currently taking more casualties of violence than Craig Joint Theater Hospital. There are certain aspects of military medicine that are profoundly different, including… Read more »
Dr. G., thank you for your kind words and for your wisdom. I’ve actually done just what you said, questioning (gently) their experiences then checking online for the units, etc. Recently found one who claimed to be 82nd Airborne but almost certainly couldn’t have been from the story. I never served in any combat theater, or even on active duty, but many years ago was an ANG flight surgeon, so I generally know the right things to ask. Were you there during the surge?
Exceptionally written Ed
Thank you Tom. It means a lot coming from a mentor.
Thank you for the reply and I applaud your efforts. During the Surge, I was still an eager medical student… I have only had the privilege of coming to this conflict during the last gasp, and although things have winded down, it appears to be far from over and I write this from a cold place in the middle east. A mentor of mine sent me your article, probably because she believes I could be the subject of your article. We all go through ups and downs dealing with tragedy differently, and I haven’t been around long enough to say… Read more »
Ed, great article. Our medical culture of compassion for each other is quite distorted for a variety of reasons. I hit the burnout three years ago and have been redesigning my personal road map ever since. I arrived to medicine with my own brand of PTSD as I think many do as those who want to serve know what it is like to be in situations where compassion and support are lacking. You might like reading The Body Keeps Score by Bessel Van Der Kolk MD. Five more years of full time and I am done.