PART 1 IN A TWO-PART SERIES
Emergency medicine is a paradox to be managed, not a problem to be solved.
I was checking out a few weeks ago to the night attending after a busy evening shift in the “urgent care” area of the ED. When we say “urgent,” we often mean people who are not sick in the ED sense of the word. It was a Sunday evening, and all of our patients' physical and emotional inconveniences had reached a point where the pleasurable activities of the weekend could no longer blunt the discomfort they were experiencing. The waiting room was packed. Patients were frustrated. They were lining up at the front desk in waves.
The intern I was leaving behind is a wonderful and intelligent woman who passed on numerous opportunities in other specialties to join our program. As I looked back at her on my way out the door, she looked at me with a sense of futility. We all know what she was thinking: “Why are they all coming here now?”
But the bigger question for the emergency medicine resident is whether you can do this type of work for the next 30 years? You will be 30 years older or dead; there aren't any other choices. You have to understand, however, that the only thing that will change about your work in the ED over time is you. The patients will keep coming. They will not change. They will not get smarter, more interesting, or less manipulative. You, on other hand, will get older and older in a business that is essentially a young man's game.
Most residents go through a period during training when their feelings of frustration or even despair become more intense. The peak usually occurs during the winter of their second year. It's cold and dark outside. The patient census goes up, influenza rages, dysentery outbreaks increase, the waiting room gets more crowded, tempers get shorter, and the resident is too far from the end of their training to see the light at the end of tunnel. Buyer's remorse sets in.
If this describes how you are feeling now, remember one thing: We all have gone through it. Look at your attendings. They had these thoughts as a resident, and if they are honest, they have them periodically over the course of their career. Your feelings now are completely normal, and they will come back from time to time. It's part of the business.
When my wife asks about my shift on a given day, my usual response is framed in how much I liked my patients. Most of the time, they have been great, and I am reminded that only a very small percentage is driving me nuts. Most patients are nice, polite, and thank me for my help. But it only takes one or two of the difficult patients to cast the entire shift in a negative light. These patient interactions become amplified in my head and extrapolated over an entire shift or even a group of shifts, and the emotional charge of these events makes it seem like the world is full of challenging people.
What do you do if you find yourself in this situation? Don't panic. Understand that it is part of growing into an emergency physician. You are paid a large salary after residency because the job is not easy. It is hard physical, mental, and emotional work. But also make a point to find out what you like and do not like about emergency medicine, and create career opportunities that mitigate the negatives and optimize the positives.
This specialty has so many opportunities beyond being a pit doctor. No other specialty has as many diverse opportunities as the training you are going through now. Next month, I'll provide ideas on how to create the career that maximizes your satisfaction with life.
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