I was a tumultuous cloud of hope and fear as I tiptoed into my new job on a recent Sunday after five months off. By Wednesday morning, with my first three nightshifts behind me, I had already stayed late three mornings to keep up with charting in an unfamiliar EMR and succumbed to stress-eating chocolate at the nurses' station. I was reacquainted with the challenges of staying awake all night, the frustration of trying to order a drip while my patients were waiting, and the chaos of downtime. My neck must not have been used to the weight of my stethoscope, because, just three shifts in, I feel like I have stethoscope-induced cervicalgia. Or EMR-induced cervicalgia from getting reacquainted with staring at a screen so much.
Coming back to work has been eye-opening. Yes, I learned that the headaches, or neck aches in my case, will always be there. But what surprised me was seeing, as if for the first time again, all the little gifts in what I do that I had taken for granted. The best gifts this time of year come not from a credit card swipe but from the little blessings in our lives. Seeing our beloved specialty through fresh eyes, I realized just how many gifts there are in being an EP.
It is a gift to get a glimpse of raw humanity. People in crisis are stripped down to their most quintessential priorities, and through them EPs get the gift of perspective. We see loyalty and love as parents hover over sick children or as children hold the hands of aging parents. We see what motivates people to heal and get home—work, pet, or, like me, kids. Being reminded of what really matters from my patients' vantage point is a blessing.
The opportunity to piece together a diagnostic puzzle is also a gift. I forgot how much I love to think through differential diagnoses and solve the mystery of what is, or at least what isn't, wrong with my patients. Correctly predicting an x-ray feels like a dorkier version of Babe Ruth calling his shot. A difficult question is the gift of a challenge. Every opportunity we get to make a diagnostic home run in an atypical presentation gives us the gift of cognitive fulfillment.
Treating patients gives us the gift of “I did it” moments. I had forgotten the joy of seeing the skin come together as I suture, all the ports of a central line flush, an asthmatic begin to breathe normally, and a pained face relaxing. We get the gift of satisfaction not only from mending the sick but also from reassuring those who aren't. Sometimes saving the day is as simple as reassuring grandpa that he'll be able to go home and play with his grandkids. I am lucky to be the one to write the discharge orders and announce to the patient that he gets to go home, usually to big smiles all around.
The Gift of People
When I started my new job, the warm welcome I received reminded me what a gift camaraderie is. Without it, a hard job is made unnecessarily harder. The collegiality of fellow doctors, nurses, and EMS makes the workplace fun and comfortable. Walking into a room to suture and finding a lac tray already set up for you is a little gift that makes a rough shift a little easier. Finding coffee on my desk at 2 a.m. from a nurse I just met is not only the gift of caffeine, beyond integral to a night doc, but also the gift of welcome and acceptance.
The forgiveness of fellow docs, scribes, and nurses as I'm learning a new computer system, the medical director who tells me not to stress but to take my time during orientation, and the extra time a colleague takes to explain how to do something are more than just patience and helpfulness. This is kindness to a new teammate. It is a gift to have team members who are not only trying to make patients better and keep the ED running efficiently but also trying to take care of each other.
Of all the gifts of being a doctor that I'm newly appreciating, the doctor-patient interaction means the most to me. We get too jaded from the looks of annoyance, impatience, and incredulity to enjoy the looks of gratitude and hope patients often give us. We get tired of interruptions and repeatedly explaining things to realize what an honor it is to have knowledge people need and to have folks hang onto our every word. We expect patients to wait for us, then forget to appreciate the remarkable calm and forgiveness they display as they stay hours for a consult or test result. We take for granted that they share their fears and health secrets seconds after we meet them. Their trust is a gift and a privilege.
Just as it is a gift to have patients appreciate me, it is also a gift to be able to show appreciation and kindness toward them. I am lucky to be in a situation where something so easy for me, like bringing a little old man a blanket or laughing at his corny jokes, can mean so much to him. It is a gift to be able to make a scared child grin just by smiling at him. It is a gift to have the opportunity to be kind to people who are not being kind to me. It is a gift to be the one bringing enthusiasm into a gloomy room. I waste too much time doing things that make no difference, so I am learning to relish doing things that make all the difference.
Going back to work after a long break has made me realize that caring for patients brings out my best self. It is a gift to be able to meet their expectations. Patients believing in me and trusting me with their lives makes me believe in myself. All my years of training, work, and experience are made worth it in the gift of three beautiful words: “Thank you, doctor.”
A year ago at this time, after more than a decade in the trenches, I felt burned out. I had lost sight of the beautiful parts of being an EP. In my frenetic attempt to keep up with a litany of tasks, I was rushing through moments I should have been treasuring. Now, after a few months off, I feel refreshed and renewed. I can appreciate all the little gifts we get as EPs that I had taken for granted before, and I can get back to enjoying this glorious mess we call emergency medicine.
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