I was talking to some new friends over lunch recently at the nationally renowned Hominy Grill in Charleston, SC. Any place with a fried green tomato BLT and shrimp and grits for breakfast has my vote!
To the point: My question to these esteemed emergency medicine educators was this: “Do you ever have irrational fears about the people you love because of what you do?”
The answer was a resounding yes! Like me, they worried when ambulances were dispatched while their children were out with friends. They worried when their spouses drove in heavy traffic. The list went on. And I nodded my head in agreement.
I have been contemplating this question for quite a long time. What are the consequences of years in the emergency department? Sure, I know: anger, bitterness, frustration, distrust, and cynicism balanced, fortunately, by compassion, perspective, appreciation for life's gifts, love of common people, and the ability to hang out with heavily tattooed bikers, drunks, and former felons without feeling the least bit uncomfortable.
But what I mean is this: What emotional, psychiatric consequences are there? What scars do we carry deep inside? I don't think we acknowledge this; we certainly don't address it. But the truth is, our specialty takes us into the heart of terror, into the midst of the worst situations humans can experience. All roads, as we know, lead to the emergency department.
The abused child, the raped woman, the burned worker, the assaulted senior citizen, the addicted teen, the mother dead by suicide. The new diagnosis of cancer or HIV or hepatitis. We see the schizophrenic young man who wanders away; we see the demented husband of 50 years who cannot recognize the love of his life.
We tell loved ones that their dearest is dead. We listen as families wail and collapse to the ground in the emotional equivalent of a hurricane, suddenly thrust from normalcy and hope to terrible brokenness and stunning loss.
It's a common fact of the job. We talk about it a little. We teach students and residents how to break bad news. And we tell them about the primacy of their own relationships, and explain the perils of using drugs or alcohol to cope. And then we send them off the way we were sent off, lambs before lions, to face a life of emotional maelstroms.
I wonder, often, how common post-traumatic stress disorder is among our population. PTSD is in the news a lot. We associate it with terrible trauma, with death and the threat of death, with disaster, with terrorism and combat. We shake our heads in sympathy with the young people shaken by tours of duty in Iraq or Afghanistan, even if they did not actually pull a trigger or see death. Their proximity to those things is sufficient to win our appropriate concern.
And yet. And yet. Day after day, night after night we go into a workplace where we have no control over who or what comes through the door. We have no way to predict what we might see. Certainly, we might spend a shift in utter boredom (hey, it could happen!) or we may see something so horrible that it changes us forever. We may leave having been stained with the blood of a police officer, coughed on by a patient with tuberculosis, or tearful from giving terrible news to someone we knew.
We go back, over and over, to the same rooms where we saw death, the same floors that were littered with dressings and body fluids, the same rooms where we delivered the terrible news. And we do it for years. Decade after decade, we accumulate stories and experiences which, taken singly, would send the average citizen screaming to his psychiatrist, and not without reason.
But we? We are rich doctors. We are educated. We are expected to do it, to show up the next day after the horror of the day before. We are not excused because of the terrible things we endure, but instead wear them as a tragic badge of honor, even as we die a little inside from fear, from worry, from taking all of those things and imagining how they might appear in our own lives, from the fear that we will make a mistake in the midst of chaos and add to the pain in the world.
I don't know how many of us meet the strict criteria of PTSD. But we experience trauma to our hearts and stress to our souls. If you have ever wondered about this on the drive home or in the hours before work, if you have ever contemplated it in the night between patients, in the fog of exhaustion, or decompressed from it on the beach with your family, then you aren't alone.
I'm writing this to say your fears, your terrors, are common to all of us who serve our tours in the emergency department. And you are allowed to be shaken by them, to be wounded by them.
I hope you will not let them shape you or break you. But I fear that much of what we call burnout, much of our bitterness or anger or bad attitudes are simply our attempt to express acceptable emotions over the difficult things we see, do, and remember ever after. Because for some reason, we are not supposed to be affected, no matter how much misery crashes on our lives like tsunamis.
It's high time our colleagues, our employers, our friends, our educators, and even our politicians recognized that money, education, and title don't ease the pain and the fear that is inherent in our work.
Perhaps, however, the most important step in healing would be for us all to admit to ourselves that it's a tough job and the consequences to our lives run deeper than circadian problems and contract negotiations.
And that even healers like us have wounds too deep to fully understand.
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