My dream brought up an interesting question.

[EM2HPM]

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So I am a student wrapping up my third year. A few months ago I did my EM rotation and fell in love. I loved the variety of complaints that came in, the pace of the ED, the ability to do procedures, and the overall attitude in the ED. I decided that I wanted to go into EM for residency and started talking to residents, attendings, and getting involved in research. I have never wanted to specialize too greatly and at first thought I would go into FM or IM. I think EM draws me away from that because I have the ability to see very sick patients, run codes, do more intubations, and have more "critical" or acute situations to handle.

Then I had a dream that I was an attending and had 3 very sick patients and had a code roll through the door. I realized that as a student rotating you can get too wrapped up in seeing the "cool" things your attending is doing because in reality you are not the one with the pressure on you. The question that came to my mind is would I really enjoy being put in that situation? Managing someone in shock, another patient that could deteriorate quickly, and running a code at the same time. It looks really exciting as a student because I can just watch and really not have any responsibility. I generally think once fully trained I would much rather do that then say round on patients like in IM. So I guess my question for those more experienced is how can you tell if you are cut out for that or not? I feel like I do my best work when the pressure is on, but I have never actually been put in the situations like you will get in the ED. For those in residency or attendings how do really stressful situations wear on you? Was becoming a resident or an attending what you expected from your views as a student? And how do you become comfortable managing several difficult patients at the same time?

Sorry if this is long I still have a big decision to make on what I will be spending 30 or so years doing for the rest of my life and want to make sure.

 

[EM_Rebuilder]

Your training will prepare you to handle those 'stressful situations' in such a manner that they are less stressful.

Chances are you will train in a high acuity place and chance are that you will work in a lower acuity/less busy place.

I think most of us will say that 'dealing with three sick patients' is not all that stressful. Its the 'weird abdominal pain in the elderly' or late aged headaches, etc that are more stressful to me as their disposition is not as clear cut. Three septic, hypotensive, pnuemonia patients? I can intubate all three, and get central lines and art lines it without thinking much into it..and the ICU cannot bulk at the admission. Sure, occasional a tough intubation comes up or even a tough line... but thats not the norm, and even in those situations, we have backup plans and then backup plans to those.

I think most of us could literally run code after code for 12 straight hours and not be stressed. Sure we might be tired from standing there and doing it.. but I dont think many of us would truely be stressed.

Now.. If you are in podunk-ville, are the only physician, have one nurse, and the helicopter is grounded, and a pickup carrying 6 people in the back end rolls over, and three of those patients are hypotensive... Thats stressful; but thats a rarity, and even then, outside of IV and fluids and trying to get transfer established, theres not much you can do.... My stress in that situation would not be so much that I do not know what to do, but that there is nothing I can do and yet they are likely savable people that I may have to watch die.