I was standing on my red tape strip six feet in front of an older man waiting to get into Trader Joe's. He asked if masks were mandatory. I wasn't sure, but I had one on anyway. He wanted to talk, and I wanted to get in and out as fast as I could. He told me about his alternative medicine doctor, his views on masks and social distancing, and his take on whether the whole COVID-19 thing was real. The whole time I was just biting my tongue trying to make small talk without blowing my cover.
As I prayed for the line to move faster, he finally asked me the question I was hoping to avoid. “What do you do? Are you still working?”
“You don't want to know what I do,” I said.
That did not go over well, of course, and piqued his curiosity even more. I never really like to tell people I'm a doctor, usually because I just want to interact without any of their doctor baggage entering into the conversation or without having to troubleshoot their medical problems in 50 words or less. Nowadays, though, I am a little afraid that I'll be seen as a pariah, run off the ranch as a carrier of the current plague.
But I ‘fessed up. “I'm an ER doctor.”
“Oh,” he said.
The lady behind him at 12 feet perked up. We are off to the races. He asked how many cases we had in our hospital, how many in the ICU, if we had ventilators, the whole nine yards. I was thinking I could lay HIPAA on this guy and get out of this conversation. But he wanted to know where I went to med school and where I did my residency. I was actually impressed by how fast and effcient the Trader Joe's line moved, but it still wasn't fast enough.
He thanked me for doing what I do. These are unprecedented times for the appreciation of health care workers. Emergency physicians, NPs, PAs, nurses, clerks, techs, first responders, housekeepers, and hospital staff in general are getting recognition for showing up and manning the wall. Don't get me wrong; these are unusual times. Some hospitals are overrun with the sick and dying, and resources are scarce. Countless have made heroic efforts, and some have paid with their lives to serve. The recognition and appreciation are well deserved.
Here in my hospital on the coast of central California, we are keeping up and have not seen the surge yet. I don't want to seem ungrateful or imply that these aren't extreme conditions. But I told him that this is the way it always is. We are there for you all the time. We may not have a pandemic going on all the time, but there is risk involved every day. He said to me, “Well, you're not exposed to infectious disease.” I let it go.
I've been in the ED for 25 years, 28 if you count residency. Getting thanked feels good, but if kudos and thanks motivate you, then working in the ED is the wrong place for you. Most of our best work is done on people who wake up in the ICU and never even know we exist. It reminds me of when we thank war veterans for their service. Invariably, they say they were just doing their job.
Just doing our job is really all we ever want to do. That job is what has been lost until now. A few months back, out of frustration, I adapted a speech by Colonel Jessup (played by Jack Nicholson) from “A Few Good Men” to share with my partners. This came out of frustration, fatigue, and a touch of cynicism. I was sick of Press Ganey scores based on an n of 2, throughput measures, sepsis metrics, and metrics in general, and I vented to a generic administrator with this:
“We live in a world that has walls, and those walls have to be guarded. Who's going to do it? You, CEO? You, middle manager? You...? We have a greater responsibility than you could possibly fathom. You whine for Press Ganey, and you curse medicine. You have that luxury. You have the luxury of not knowing what I know. That patient satisfaction scores and metrics don't mean good medicine. And my existence, while grotesque and incomprehensible to you, saves lives. You don't want the truth because deep down in places you don't talk about at parties, you want me on that wall, you need me on that wall.
“We use words like evidence, commitment, accountability. We use these words as the backbone of a life spent defending something. You add them to your slogans. I have neither the time nor the inclination to explain anything to anyone who lives and sleeps comfortably above the safety net that I provide and then questions the manner in which I provide it. I would rather you just said thank you and went on your way. Otherwise, I suggest you go to med school, endure residency, stay up all night, and stand a post. Either way, I don't believe in what you think you are entitled to.” (Adapted from “A Few Good Men” by Aaron Sorkin.)
It is harsh in retrospect, I guess, but I got it out of my system. My point is that we have always manned the wall and will continue to do so no matter what the climate is at home. Soldiers returning from World War II were heroes, while those coming home from Vietnam were called baby killers. Soldiers all, doing their jobs, serving their country and fellow Americans.
It's amazing to me that it's taken a pandemic to make beds upstairs rapidly available, to remove psych holds from the ED, to get the type of video laryngoscope we requested years ago, to encourage or even prevent those with nonemergencies from coming in. Our census is actually down, and revenue will be too, but you know what? Seeing true emergencies for a change is actually refreshing. It's what we trained for. It's what we do.
It's good to be appreciated. For some reason, though, it makes me a little uncomfortable to be in the same category with those in Italy, New York, and New Orleans. Just because I wear a powered air-purifying respirator in a warm zone doesn't qualify as heroic in my mind. There are true heroes emerging in this crisis, no doubt. The rest of us will soldier on regardless of the battle, doing our job as always. This too shall pass, and it will be interesting to see if there is a big reset to the system. Telemedicine might replace us all. In the meantime, though, I'll see you on the wall.
Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, CA.