Why you should keep going back to the emergency department


There is discontent in the house of medicine. So many physicians struggle. They seem to wade through uncertainty every day; uncertain about diagnoses, about pain, about disposition. We find ourselves uncertain about our jobs, our futures, our finances.

The consultants we call are uncertain about their practices; whether they can remain viable in the coming years as medicine evolves into something we yet may find unrecognizable.

Some days, as I enter my 17th year of practice, I don’t know if I can bear to walk around our little department for ten or twenty more years, like some gerbil on an exercise wheel. I am uncertain if I can bear the weight of more entitlements, more confabulated stories, more regulations and manufactured drama. I wonder if I can endure decades more of circadian assaults on my brain.

We all face our moments, our days, our years of uncertainty; but it seems to grow more intense, more immediate; especially for new physicians. I wonder how long many young physicians that I know will continue to practice. I fear that the days of careers lasting until a ‘ripe old age,’ are no more; and that the ripe old age of exit from medicine may be 10 years from onset of practice.

But last night, while making my rounds from room to room, I encountered several reasons to keep coming back, and keep facing my uncertainty with juxtaposed certainty of purpose. One was about five, with abdominal pain, and she had soft, long brown hair. When she smiled, she was a fairy-princess. She laughed at my jokes, as I sat next to her on the exam table and tried to show her I would not hurt her. Her mother, well-known to me, is not a paragon of stability. But this child lit up when I focused my attention on her.

With dark brown eyes, another had (of course) abdominal pain. He said, with the hurried anxiety of a seven-year-old, ‘are you going to hurt me?’ ‘Now, why would I hurt you?’ We smiled at one another while I examined him. We talked about our favorite breakfast foods. He shared a name with my youngest son, Elijah. A good name.

One had a laceration by his eye; his pediatrician couldn’t convince the child to be still; his doctor was terrified of ‘getting glue in his eye.’ Nervous as a colt, the boy’s eyes darted back and forth. ‘Let’s wait, can we wait?’ I said, with confidence learned from fatherhood and experience, ‘Nope. Let’s do it. You’ll be fine. Here goes.’ And we were done. ‘I like that doctor,’ he told our nurse.

Another infant had a mother at the breaking point; worried to death over ear infections and assorted antibiotics. The child had a mild pneumonia; I sent her home with an antibiotic prescription after convincing mom that all was well.

Over the years, how many have I seen and held? How many sick children? How many blue babies, rushed to our department, struggling to breath? How many terrified little boys or girls with cuts and fractures, ear-aches and sore throats, appendicitis and head injuries? How many parents concerned over possible overdoses that turned out to be nothing, but still needed my eyes and hands and knowledge to be certain?

We may rail against so much that we do. But our smallest patients truly need us. They have not contributed to their own dysfunction. They have not abused their bodies or abused the system. They do not threaten me with harm or call me names. And unlike so very many, they don’t even want to be in the emergency department. They almost never ask for pain medicine, and have little to no interest in disability.

They need us because they are sick and dying. They need us because their parents are too young or inexperienced, and just need to be helped through a stressful time. A few because their parents are dangerous and stupid, and their children need to be identified and rescued.

If we aren’t there for them, in a time when health-care is harder and harder to find, who will be? If we will not stay up all night to be available, will not twist our schedules into pretzels to cover the shop, if we will not be their voices in a wilderness of sickness, who will?

If there is any reason for me to continue working, to overcome my uncertainty of purpose and calling, it is so that I can be there for the children. But not just the children of strangers. What will happen to my children, and to theirs, if we all abandon our work? Who will rescue them in the night? Who will get the oxygen back into their struggling lungs? Who will comfort them in their pain? Who will diagnose their internal bleeding, their appendicitis?

If I quit in anger, what example will that set to my own, who may yet be physicians? If I decide that even the children aren’t worth my own discomfort, what message will that send to my sons and daughter?

We all have a breaking point. I am not judging; I’m only reminding myself that there are good reasons to keep going back to the ER, despite uncertainty and lunacy.

I fully understand why so many leave practice. I just hope that we can find in ourselves the love, the patience, the passion, the endurance to continue to ‘suffer the little children.’ For the little children suffer enough already.

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