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Life in Emergistan

Life in Emergistan

The Liberating Feeling of Small Victories

Leap, Edwin MD

doi: 10.1097/01.EEM.0000650984.91884.42
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    It is often the case that we judge ourselves by the great cases—the difficult intubation we pulled from the brink of disaster, the cardiac arrest patient who came back a week later with his grateful family and pizza to say thank you, and the suicidal teenager we rescued who goes on to medical school to become one of us.

    Sometimes it is the night-from-hell tale during which we overcame power outages, blizzards, a small nuclear blast, and wild dog attacks, and all of our critical patients pulled through, thanks to our perseverance, creativity, and knowledge.

    These are the tales we share online. These are the stories we pull out when we speak to aspiring students or share around the table with friends and family. Yet they are only part of the tale.

    We are surrounded by so many amazing physicians, so many superstars, and it is all too easy to think of glory as the natural and inevitable background and purpose of all our time in the ED. It is all too deceptive to see success as the consistent, natural outcome.

    Anyone who has worked in the specialty long enough, however, knows that for the lie it is. It is important for our collective and individual sanity to face the hard truths of the job. Sometimes we lose. Some shifts are hard. The light we hope for at the end of the tunnel sometimes doesn't flicker on to guide us. We slog through complexity and confusion, unsuccessful procedures and hopeless transfers, and angry, demeaning consultants, and in the morning we go home wondering just why we chose this career. Worse, we wonder if we're even qualified.

    Falling Short

    Of course, this flies in the face of what we see and hear on social media, in publications, at conferences, and on podcasts. What we observe is typically biased in favor of greatness. After all, who would listen to a podcast called My Week of Failure in the ED?

    Who doesn't want to be seen as a great physician? Which physician wants to suggest that sometimes bad things happen and lives aren't saved? Or that physicians don't have all the answers? Or that procedures don't always work out? That's bad PR, for sure.

    We won't have any of that. It smacks of our own internal doubts and demons. We have also been educated to believe we are brilliant and capable and that failure to be both would inevitably result in litigation.

    But, dear doctor, sometimes none of it works out. Sometimes all those years of reading and learning and practice just don't save the day. Sometimes it's because we're tired, we missed something in the chaos, or our skills weren't good enough. Often, it's because the patients were too sick, too injured, or too confusing for us to succeed.

    It's no crime to go home at the end of the day thinking you weren't a superstar. In fact, it's probably more common than anyone wants to confess. Our fear of vulnerability won't allow that. What would be our penance? Shame? Anxiety? Sleeplessness? We have those anyway without the public misery of honesty.

    Sometimes our successes are remarkable, even if they fall short of glory, even if they do not rise to the level of inspiring speeches, case reports, and other breathtaking war stories.

    Success may be the reassured parent, the person directed to follow up for that new nodule or for suspicious chest pain. Success can take the form of identifying depression or discussing addiction.

    A Liberating Reality

    A few weeks ago, I saw a patient who is mentally challenged but often comes to the hospital for headaches. She couldn't pronounce migraine, but we knew what she was saying. She also said her eye was hurting, red, and tender.

    No matter what I tried, I couldn't get an intraocular pressure. No device worked, and she was unable to cooperate. After multiple frustrating calls, I reached a local ophthalmologist who graciously told me to send her over.

    I saw her again not long ago. Her eye was tender. “I had a cataract taken out,” she said. I wasn't convinced and called the ophthalmologist again. “Yes, she had a YAG iridotomy for glaucoma. Send her back over!”

    It wasn't glorious, but that was a win, one veiled in confusion and uncertainty and frustration but still a win.

    I'm good at what I do. But this is a job that keeps getting more difficult as we're simultaneously expected to do more with less while being held to an ever-increasing standard. I just want everyone to learn to embrace the formative nature of difficulty and the humbling reality that even when we do all that we can, it may not be enough. That's liberating.

    Equally important, I want everyone to learn to revel in small but significant victories whenever they appear. In the midst of our daily darkness, they are blessings indeed, to our patients first and also to us.

    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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