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Life in Emergistan

Just Another Day in the ED, Saving Lives

Leap, Edwin, MD

Emergency Medicine News: May 2019 - Volume 41 - Issue 5 - p 5
doi: 10.1097/01.EEM.0000558177.00629.a8
Life in Emergistan

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I had the privilege of speaking to some emergency medicine residents recently. What a wonderful group they were. Intelligent, compassionate, and courteous, they exhibited the traits we all want in those who will care for us in our times of crisis. I talked to them about life after residency, and asked them a question meant to give them perspective on their lives so far: Have you ever saved a life?

They sat still, uncomfortable. They looked at one another and at me. A hand or two edged up slowly but not with certainty. They were tentative about this important question.

“You don't think you've ever saved a life during residency?” They nodded, and a few seemed to agree. I think they were just humble. But maybe there was something more.

The point I was making to the residents was that while they will make mistakes, on the balance they will help far more people than they will ever harm. Even if they stopped practicing medicine at the end of residency, they would have done more good than many people do in an entire lifetime.

It may be that they, like so many good physicians, are unnecessarily hard on themselves. We all tend to focus far more on our shortcomings than our successes, on our inadequacies, not our skills. It's difficult to overlook even small mistakes because we learn early on to see them as value judgments on our worth and character. That's terrible, mind you, but we do it.

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A Societal Good

Maybe what we have done is convinced ourselves that a job that pays well is little more than a job. Maybe we've come to believe, tragically, that none of the lives saved or lives changed, not a bit of the suffering eased is special because it's just part of the job and because we are well compensated. If so, that's unfortunate. A job is what we do to support ourselves and those we love. Any job where we do our best and use our skills to care for those we love and provide a service to others is a societal good.

A job in which we actually help people survive illness and injury, actually guide them through difficult social situations, one in which we ease suffering and make death less terrifying is worth celebrating. That's a gift to our patients and to ourselves. I think, though, that something else is at work in the failure of those residents to acknowledge that they had saved lives. I think that the daily chaos of our work in the emergency departments of America is so great and so intense that we simply can't see it as anything other than normal life.

I was speaking to one of their faculty who is a friend. He laughed about the fact that his wife asks after every shift what he saw. “Oh, nothing really,” he said he usually responds. “Nothing really” to many emergency physicians, however, could include CPR, a pericardiocentesis, a resuscitated septic infant, a multi-trauma, a cerebral hemorrhage, and a life-threatening overdose. Early in our careers these stand out. Later, not so much.

I read once that time seems to move faster as we age because we've seen most things already. Unique events are not markers of time but background. Maybe after less time than we realize, all the bad things we see, all the incredible ways we intervene in lives, even all the lives saved by recognition of danger and quick action or skilled procedures, simply blur into the background of just another day. “What did you see?” Our brains genuinely think it was nothing.

But it was something. The nothing that we see every day would leave many people wrecked and stunned, frightened and panicked. This is not because they are weak. They merely respond the way humans do. We must remember that most people never see a dead body. We see one and eat pizza.

The reality is that we are hardened to these things, trained about them, educated in a crucible of suffering and forge-fire of intense education where we learn to suppress the shock, the surprise, the horror, the anxiety, and turn all of it into thought, action, and planning tempered with kindness.

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Dr. Leappractices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available atwww.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, http://edwinleap.com/. Follow him on Twitter @edwinleap, and read his past columns athttp://bit.ly/EMN-Emergistan.

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