I recently heard Dr. Anthony Fauci speak during a webinar,∗ and he said something I hadn't heard in a long time. Asked how he was handling the long hours and constant conflict surrounding the pandemic, Dr. Fauci said he had learned to suck it up during long stretches of every-other-night call in residency. He said that ability was carrying him through now.
That made me think of the Navy SEALs. Their training and qualifications are legendary. Try carrying a telephone pole overhead on the beach with a few friends or doing sit-ups on a 58-degree shore break. How about jumping in the deep end of a pool with your hands tied behind your back and feet tied together? They push the limit of sucking it up.
In fact, one of their mantras is “embrace the suck.” To get through it, they not only acknowledge it but embrace it. Many SEALs become motivational speakers and exercise gurus after active duty. People want to learn how they think and what they do. Accomplishing seemingly superhuman feats is impressive and respected, as it should be, but most people don't really want to put themselves through that much pain and hard work to get what they want. Most people don't want to experience the suck, much less embrace it. My dad used to call it character building. Every time he told me something was a character-builder, I knew that was code for it's going to suck, but I was going to do it anyway.
I agree with Dr. Fauci; residency did help us learn how to suck it up. I think we in the ED do it better and more consistently than any other specialty. Our shifts often demand it. We never know what's coming through the door or how busy it's going to get. If a partner is stuck in a room, then you own the whole department for a while, and you suck it up. End-of-shift bolus of patients, pandemic, mass casualty, computer downtime: Suck it up. Waiting for a transfer or carving time out for a procedure: Suck it up. Staying late to chart or to avoid a worrisome signout: Suck it up.
Dr. Fauci evidently had some suck-it-up muscle memory. I don't imagine he had been taking that much call before the pandemic. I think most of our consultants knew how to suck it up at some point too. Now it seems some of them want to avoid it and certainly not embrace it.
I tried to admit a patient the other day. I was presenting the case and got no response. I kept talking, giving details. Sometimes I feel like I'm selling a used car. I kept providing more and more details. Nothing. Then I realized the call was dropped. How pathetic is that? I'm so conditioned and used to pushback that I thought the silence meant I hadn't convinced him of the legitimacy of the admission. Not all of them are like that, of course, and I'm not opposed to dialogue. It just seems like pushback shouldn't be the default. A little more suck it up would be nice.
I'm not convinced sucking it up is even taught anymore. We have a couple of different residencies at our hospital, but neither one is emergency medicine. I asked one intern if he wanted to see a cardioversion I was about to do. He said he'd like to, but his shift was over at 5. Another one was asked by her attending to go see an unusual case in the OR, but she declined, saying she needed some sleep. That was unheard of when I trained. Of course, the Dead Sea scrolls were hot off the presses then too.
I've heard the U-word used a lot lately. It's kind of a get-out-of-jail-free card. It is used pervasively in our culture today for sure, and it is unfortunately creeping into medicine as well. The word is “uncomfortable.” It seems that if you say you are uncomfortable with something, then you don't have to do it or hear about it. We just can't have anybody be uncomfortable these days.
That is just not possible in the ED. Every shift, every time we step into the department, we are guaranteed something will make us uncomfortable. What do we do? We embrace it. We take it head-on. We do our job. We are the best at being comfortable with the uncomfortable.
I feel uncomfortable suggesting we are like the SEALs. No one is shooting at us, at least not literally. We do risk our lives at times, I guess, but still not on par with them. What we definitely have in common with them is ownership. We take ownership of what we do and hold ourselves accountable to a higher standard than most. We take a stand. We embrace whatever comes in. We suck it up.
∗ Watch the SAEM National Grand Rounds, “COVID-19 Vaccine Distribution and What it Means for the Emergency Department,” with Anthony Fauci, MD, at https://bit.ly/3y1sui2.
Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, CA. Read his past columns athttp://bit.ly/EMN-SameShift.