I’m about to go to work.  During the course of my emergency department shift, I may see everything from an ankle sprain to a complex poisoning, a dying patient with cardiogenic shock to a corneal abrasion.

In the course of my career, at a mid-sized community emergency department, I have opened the chests of three individuals with stab wounds to the heart.  I have cared for paralysis, profound hypothermia, cardiac rhythm disturbances, SIDS deaths, assorted gun-shot wounds, metabolic derangements, venomous snake-bites, near-drownings and untold other complaints that have afflicted God’s creatures who came through my ER.

The fascinating turn of events in medicine is that, even as my colleagues and I push the limits of our knowledge and skills, medicine is filling up with doctors (and frankly with nurses) whose battle cry is ‘I’m not comfortable with that.’

In my residency (here we go with the old war stories), we flew on a medical helicopter called Lifeline.  On Lifeline shifts, you might fly to and enter a small rural emergency room and be met with utter and unimaginable chaos.  I saw a friend doing a thoracotamy once.  I did escharotamies on the charred skin of terribly burned adults and children.  I lay in the mud intubating a gunshot wound. But do you know the one common denominator?  None of it made me especially comfortable.

I think we’ve lost our way.  Medicine used to be a place where people went when they were willing to take risks to care for the sick and dying.  I mean, we knew everyone died, and most everyone became injured or ill.  So we figured, ‘I’ll give it a shot!’

Now, forgetting the universality of death, forgetting the near universality of error, and ignoring the great value of bold attempts to do good, our culture rejects all risk and our physicians have become soft and cowardly, hiding behind the fear of malpractice or worse…censure by regulatory bodies, loss of profit and inconvenience.

Where are the cowboys and cowgirls?

I won’t be comfortable with everything tonight.  But with God’s help, I’ll sure give it a whirl.

I hope physicians learn to rediscover the joy of risk.

Otherwise, we’ll be stuck with a profession full of insurance adjustors who sound like Bartelby the Scrivener…

‘I would prefer not.’

God help us!  And all our children, and theirs.

Edwin

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