Moments in EM that reassure you you're in the right place

[loveoforganic]

EM is a field I have my heart set on - the pace, the (very) interesting cases, etc. However, I really need to feel that I'm making some kind of a difference in some people's lives, at least moderately often. Does EM offer this for you all? In between all the anvil-in-the-urethra meth addict cases, what kind of cases have you all had that let you know that you were where you belonged?

Thanks

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[kungfufishing]

For me, the answer lies in the care of truly sick people. No one specific case. Just nice to know that recognizing and caring for truly ill patients is what they built me to do.

 

[AmoryBlaine]

To tell you the truth in my experience these cases tend to be inversely related to the severity of the illness. I'll explain...

If someone comes in really sick (anginal chest pain, septic shock, open fracture) their definitive care is not going to happen in the ED. In those cases the dynamic is often rapid patient care with next to no focus on talking to the patient or their family. You dispo them as quick as possible and for the most part (I know that EGDT starts in the ED) the docs who save them (or fail to) are going to be elsewhere in the hospital.

Similarly there is the high-risk CC (old person with abdominal pain, ESRD w/ dizziness, new onset a fib). In these cases your final interaction with the patient tends to be, "well I don't know exactly what is wrong with you but I know you need to be in the hospital so we're going to admit you."


Stuff like lacs, simple fx, etc is when you really feel like a doc. Someone comes in with a problem, you know exactly what to do, you do it, and they leave feeling better.

The other stuff that is career-affirming is when you take the extra 1/2 hour to work on the dispo of a complicated patient. Maybe when you talk to the primary oncologist for a few minutes and figure out if you can avoid admission. These tend to be the times when patients feel like they have been listened to and leave the ED still sick but feeling cared for...

 

[Old_Mil]

The other stuff that is career-affirming is when you take the extra 1/2 hour to work on the dispo of a complicated patient. Maybe when you talk to the primary oncologist for a few minutes and figure out if you can avoid admission. These tend to be the times when patients feel like they have been listened to and leave the ED still sick but feeling cared for...

This is something that I love about the ED. I can't think of another field of medicine - certainly not the nightmarish hell that is outpatient clinic - that gives you the ability to take an extra half an hour to dispo a complicated patient while putting the patient with percocetopenia on the back burner.

Try it in most outpatient clinics and it won't be long before some RN turned clinic manager is breathing down your neck.

 

[loveoforganic]

To tell you the truth...feeling cared for...

Thanks for that reply - it wasn't what I was expecting, but it makes sense and is also appealing.

 

[xaelia]

Does every second on my medicine floor month count?

 

[Kubed]

Does every second on my medicine floor month count?

 

[EM2BE]

It's the right place when it's the only place you can see yourself. Reassurance comes when on other services and hating it there every day (maybe that's my reassurance, but may help you).

 

[WakeMedHeel]

It's the right place when it's the only place you can see yourself. Reassurance comes when on other services and hating it there every day (maybe that's my reassurance, but may help you).

I don't think you truly know you are in the right place because you find you dislike all other services. I knew I was in the right place, precisely because I ENJOYED all the other services but I knew I didn't want to do it all the time.

EM is a little bit of every thing...and usually that's all I need.

 

[Homunculus]

Just nice to know that recognizing and caring for truly ill patients is what they built me to do.

good to know the self-awareness chip we implanted starting in your model is working as intended.

kungufushing v5.0 will be a bit of an improvement on your model. we're building him to not need bathroom breaks for 18+ hours and to be primarily flourescent light and energy drink powered. v1.0 worked ok until he wandered off one day and became an archeologist. v2.0 and v3.0 got into some "i can do anything better than you can" contest and were last seen seeing which model could fit a larger fruit in their mouth.

--your friendly neighborhood mad scientist EM physician creating caveman

 

[jazz]

not everyone can handle/juggle multiple complicated, and completely different pts at the same time...

hearing consultants (who usually disparage the ER) come to the ER, look around, and say "i don't know how you guys work down here..." on a busy but not particularly crazy day is oddly, nice to hear... makes me kinda proud of our job...

diagnosing, not missing diagnoses like PE's, epidural abscesses, ischemic gut... diagnosisng acute appy in a 2 yo with vomiting... i mean these are the times when i get to love what i'm doing and feeling like i make a difference...

 

[Speed Racer]

When I see the internal medicine people bang 5 heads together for 20 minutes to make 1 decision for 1 patient; I contrast that with me banging my 1 head against the desk to make 20 decisions for 5 patients in 1 minute.....I think I might be in the right place.

 

[Aloha Kid]

Like all fields, I feel I actually love ER more now than ever. I hope the feeling continues to grow. It's not something you can get an intuitive sense for unless you are in the trenches day in and day out. The time you are on shift is demanding. Your mind will be spinning and moving a thousand clicks more that it should be. At the same time, most ER docs I know move at a thousand clicks slower with a more chilled attitude when they're simply relaxing and kicking the bucket. We are a choice group of guys and gals. In my mind we are the Peoples docs of the 21st century.

 

[Homunculus]

relaxing and kicking the bucket.

whoah. i hope to fight the grim reaper off tooth and nail. but it's good to see the EM folks being more accepting of their fates.

--your friendly neighborhood relaxing and not buying any farms anytime soon caveman

 

[dchristismi]

You know, when you see death as often as we do...

I think he meant "moving the meat" or "shooting the s%$!," both of which EM physicians are known for.

Personally, I knew by my second shift as a med student. It makes it worth it every time a patient asks where my office is and could I be their family doctor. (I tell them that I'm happy to take care of their heart attack/stroke/car crash/ear infection at 3am, but they really don't want any of those things.) It's worth it when you actually hear praise from a consultant ("Nice catch on that subtle EKG - it was a 100% R main...") or get one of those "real" saves. And I'm not talking pulling the uroseptic grandma back from the brink temporarily. You know these when you see them, and they are priceless reminders of why we do what we do.

 

[docmartin252]

It may not be all glamor all the time, but I think that you get a patient every so often that makes you want to hang around for a while longer. There was one night in the ER I work in that a patient was declared dead. The organ donor team was called to talk with the family and asses the patient. The real sad part was that it was a 28 y/o F that just gave birth to her first child a few weeks previous and collapsed without warning. The ER doc had already broke the news to the family and allowed the family to view the pt. After a while the pt regained significant brain activity, enough to send her to the ICU. I didn't see the pt again, but was told that she eventually made a full recovery, and never heard what caused her to collapse.

Special cases may not happen very often, but when you're doing routine things every shift you work, it can make the difference to keep you coming into ER for a long career.