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News: To My Patients What I've Learned from Working in the ED (or How Nurses Can Break You to Bits)

Siebe, Cory A. MD, MPH

doi: 10.1097/01.EEM.0000464085.51238.c9

Dr. Siebeis a third-year emergency medicine resident at the Denver Health Residency. He presented this talk at “Ignite Boulder” in Boulder. The Ignite series is a worldwide movement, and Ignite Boulder is the largest of the series. It can be watched here:



I've learned that my first job in the emergency department as a physician is to determine whether you are sick or not sick, and this means figuring out if you are going to die or get critically ill in the next seconds or days. This assessment takes 10 seconds, and these people get seen first.

I've learned that my job is to believe everyone. If you come to see me, you are there because of fear or pain, and you need me to believe you right now. The truth is stranger than fiction, and I want to believe you, and hope that you can trust me to help take care of you.

But I know you're lying to me, too. And that's OK, but wouldn't it just be easier if you told me what you put up your rectum, sir? But I lie to you, too, mostly through omission. I know your CT scan is covered in cancer and it's a death sentence, but I give you hope and say the diagnosis is still uncertain.

I've learned that the only people who get shot are minding their own business or on their way to church, and that there really is about a gallon and a half of blood in the human body. OxiClean or a good enzymatic cleaner is the trick for getting out those bloodstains.

I've learned that we have the best paramedics and EMTs in the entire world, and you probably didn't realize it, but it's a miracle that by calling three digits from your cell phone, you can get world-class emergency care to your door faster than you can get a sandwich from Jimmy Johns.

I've learned that I don't want to do CPR on your grandmother, but because no one talked about what to do when she died, we are cracking her ribs and putting her on the breathing machine, and it really just seems like torture for the end of her life. Advance directives aren't death panels, but rather ways to let dying people have dignity.

I've learned that when people die, I don't know how to say it. Is it “she has died” or “she died”? And when people hear this, they don't really scream or cry, they just sit there and are confused, and we both don't know what to do.

I've learned that the worst part of my day is waking up a young successful professional who had too many beers the night before and hit a pedestrian on the way home. I'm discharging him to jail, and the face I see is the face that will be his mug shot in about an hour and a half.

I've learned that alcohol really is the most dangerous drug we have, and it kills more people and causes more hurt than you could ever imagine. If you have the gene that makes you crave it, you are up for the hardest battle you will ever fight.

I've learned that heroin is a tough drug to kick, too, and people don't want to be on it, but their body wants it because they can't get the oxy they got addicted to from a few too many doctors prescribing them narcotics for their aches and pains. I know that half a gram might keep withdrawal away, and that's about $30 on the streets in Denver.

I've also learned that there is no such thing as an accident, and people make decisions that have consequences every day. But I don't know whether to blame the people or the environment or genes or policy or poverty.

I've learned that sometimes you have to hurt to heal. I know this because I stick needles and tubes into people, and it's not fun for them. And I know you have to hurt to heal because sometimes I cry at home after I can't shake it off, and I thank those patients in my heart because it won't happen again next time.

I've learned that Eminem's “Lose Yourself” has 76 million views on YouTube and lots of those are me because it gets me pumped up for a shift. I know it's silly, but what can you do? I'm nervous, but on the surface I look calm and ready, and my palms really do get sweaty.

And I've learned that when people come to the emergency department, they quickly forget why they initially came and start to hyper-focus on why we won't let them drink water, and the dynamic can become jailer and prisoner if you're not careful. But tests take time, and I'm sorry.

I've learned that nurses can break you into little tiny bits if you don't ask them their opinion or if you boss them around, or they can help you have the best shift of your life if you just listen hard enough to what they have to say.

I've learned that marijuana is probably safer than alcohol in reasonable amounts, but edibles can cause you to have the worst day of your life if you're just passing through from Florida and you eat the entire bar after the first bite didn't do anything after 10 minutes. Ask Maureen Dowd. (

I've learned that my miss rate for heart attacks is required to be zero, so I spend all of your money without even asking what your risk tolerance is. And if you're over 65, you're more likely to die if you have abdominal pain, but we get sued more for chest pain so we see those people faster.

And I've learned that 50 percent of motorcycle riders don't wear helmets in Colorado, and they say they know the consequences but maybe they don't. A devastating brain injury as a trade for the freedom to let the wind blow through your hair just seems like a bad trade to me.

And I've learned that there's no place you'd rather be if you're having a true emergency than where I work, but I'm not that good at managing your blood pressure pills. And I've learned that when people come to the emergency department during a Broncos game, they are either really sick or just not sports fans but probably mostly really sick.

I've learned that the emergency department is truly the place for anyone, anytime, and we will try to listen, do the right thing, and help you with the fear or the pain that you feel. I've learned that the most important patient is the one in front of you until someone comes in with no heartbeat, in which case you'll have to wait just a little bit longer.

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