Life in Emergistan: EM Can Be Soul-Sucking, but What EPs Do Matters : Emergency Medicine News

Journal Logo

Life in Emergistan

Life in Emergistan

EM Can Be Soul-Sucking, but What EPs Do Matters

Leap, Edwin MD

doi: 10.1097/01.EEM.0000898216.88389.76
    career, emergency physician

    I have spoken to many aspiring physicians over the years, and the one thing I've tried never to say to students is “don't go into medicine.” The funny thing is many of them tell me that other physicians do discourage them.

    “Don't do it; it's terrible,” they hear. Or “go into nursing,” or the perennial “go to law school; that's where the money is anyway.”

    They come away from those interactions questioning their passion. They are hard-working, hopeful, disciplined, and dedicated. They are willing to put in the time and effort, ready to abandon a decade of freedom. Then they speak to people living their dreams and wonder if they should abandon those aspirations for something less.

    I understand the bitterness among our colleagues, which crosses specialty lines. It's a tough time in medicine. All of us know it. From the painfully clear and somewhat skewed view of America's emergency departments, medicine seems to be in a free fall.

    We also have an odd juxtaposition in our own specialty. We are told there are about to be too many of us, but we all feel understaffed when we work. (Looking at you, CMGs.) And patients and staff alike are suffering.

    Meaning to the Struggle

    Without question, our work as physicians is frequently undervalued and unappreciated. Certainly, it can be exhausting and soul-sucking. It leaves us physically and spiritually drained and sometimes gravely wounded, as physician substance misuse and suicide rates attest.

    But being unappreciated and undervalued, frustrated and existentially confused is the story of human life and work, isn't it? From the lowest laborer to the greatest artist, from homemaker to king, humans have always wondered if their efforts mattered, if there was any meaning to their struggle.

    Yet, we know, no matter how wildly frustrating the day was, we did things that mattered, if not to the system at least to the human beings lying in front of us. All too many men and women go to jobs that do not imbue them with a sense of purpose.

    Most jobs that allow a person to support himself and his loved ones have meaning in a very real sense, but attaining that money can seem empty. Our jobs do not. In fact, they seem almost too full of purpose as we fight for patients and colleagues against the forces arrayed before us, from mundane insurance companies to death itself. This is a rare gift.

    I offer one more reason to press on if that is not enough: We cannot see the future. COVID-19 was a kick in the nether region, and we sure didn't see that coming. We don't have any idea of what is just around the corner. Who will be there for the people we love, the people we hope to love someday?

    Who will identify their illnesses, bind their wounds, stop their bleeding, save their lives? Someone will need us even if health care continues to disintegrate and remains a vast treasure trove for corporations and nefarious actors, even if we are pushed to the brink and treated even more as commodities to be bought and sold.

    They Need Us

    The forces of gravity will pull humans to the ground. The forces of evil will cause injuries, from guns and knives, from war and abuse. The microscopic world will continue to infect and cause injury and death. Depression and addiction will range across the land, robbing us of people who are precious. What will happen if we abandon this mission? Death and suffering and grief.

    A few rare lives consist of lounging by the pool on a sunny island, drink in hand, day after day, posting to social media about the weather and the food and causing mere mortals the sin of envy. But I couldn't live like that, as nice as it sounds. Odds are most of you couldn't either. I suspect those people aren't that happy either, at least not for long.

    What makes us happy is being needed, being useful, reaching into the lives of others. I say this to encourage my colleagues and friends in these dark times. I go to work each day and wonder: What fresh hell is this, as patients get sicker, transfers harder, beds fewer? Nevertheless, I never have to wonder if I matter. Neither do you, my dear ones.

    As long as I have breath and can keep some knowledge and skill in my aging brain and body, I will keep at it, if only because someone I love may need me. And the country I love may need me.

    Circling back to all of those aspiring physicians, I say do it. The price may be high, financially and personally, but if you do it for the right reasons, the struggle and the work, the lives saved and the suffering eased will be worth it.

    That will beat a life of ease hands down.

    Dr. Leappractices emergency medicine in rural South Carolina, and is the author of the column, Life and Limb ( and a blog ( Follow him on Twitter@edwin_leap, and read his past EMN columns at

    Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
    • jdeliaso9:44:41 AMThank you, Dr. Leap, for your positive voice in these difficult times. I "retired" at 57, and after six months, I was still searching for meaning in my newly directionless existence. I was able to return to work part-time and find purpose in helping others, which is still rewarding, though, admittedly, it concurrently stresses us as physicians. It is eustress that at face value is uncomfortable but on reflection is beneficial. Like you, I have heard colleagues tell medical students to run away, but I also have tried to encourage them in the noble calling that is ours. Thanks again for the work that you have done and your skill in sharing your thoughts to encourage the rest of us!
    • lvartanian12:03:49 PMDr Leap, I read your commentary, and all I can say, is “Amen!!”&#160;When you say, “The price may be high, financially and personally, but if you do it for the right reasons, the struggle and the work, the lives saved and the suffering eased will be worth it,”&#160;these are the very true reasons&#160;and principles that God gave us the abilities to work in this very ancient profession. We picked it. The profession did not pick us. So, yes, while we work and live in these tumultuous times, we need healers to replace us one day. Dr. L. Vartanian Spring, TX<br>
    • dirkwwoods9:36:09 AMWhat a beautiful essay on life. I find myself still reading your essays five&#160;years after seeing 100k EM patients and from my newer primary care perch. Whether we are victims and suckers of an evolving world&#160;or blessed to have a profession and life infused with meaning that a 5-year-old can understand depends on your take on life. What we do is hard and will never be fully understood or appreciated by those who haven't done it. Many will try to profit from and abuse our sense of duty. It really does come down to the meaning of life and whether one chooses to focus on comfort, happiness, or meaning. I think most of us want our kids to have good lives, and more than a moment of reflection tells us that a good life is not perfectly synonymous with a happy life. You clearly have found some answers to man's search for meaning. Please don't stop writing these beautiful essays any time soon.