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Nov 24, 2010


That last post, where I wrote about being totally rejuvenated at the mere sight of Colin, was a description of a momentary breather in what has otherwise been an atrocious month. Tomorrow is Thanksgiving: know what I’m thankful for? That Emergency Medicine is almost over.
This specialty once held some allure for me. I liked the shift work aspect, of course. I liked the possibility of trauma and high stakes situations where my training would matter if someone lived or died. I liked the idea of being the one to diagnose people, and get them to the right specialist.
So far, I haven’t seen any of that in the ER. Instead, I am asked to stay late, hours after my shift. I haven’t seen any trauma, but see 14 patients per shift who almost all go home with no medicines and instructions to follow up with a primary care doctor. I haven’t diagnosed anyone, but I have done countless expensive and useless workups to rule out catastrophic things that might be causing someone’s chronic belly pain that they randomly decided to get checked out at 2am on a Wednesday because they weren’t doing anything else.
While this post is not a treatise on health care or the reform that is so necessary, I will simply say that no where is our health care so clearly seen for the broken, dying thing that it is than in the Emergency Department. Always open, turning no one away, it is a physical embodiment of the scapegoat and the fool. Physicians dump their patients there on Friday afternoons or while they are busy in clinic. Patients come seeking “second opinions” and then require an unnecessary repeat of their entire workup. People come looking for drugs, food, shelter. Instead of seeing people who are emergently sick, we see people who walk in off the street with questions, needs for refills, longstanding illnesses that they are simply tired of tolerating. The resources we waste in the ER is absolutely staggering.
I’m not sure exactly when I lost my zeal, but it was around the middle of the month. The schedule itself is grueling, never working the same shift twice, constantly switching from days to nights, never knowing when you’ll sleep, eat, or see your family. I was excited at first, as everyone always is at the beginning of a rotation. I looked forward to being the very first physician-like person to see the patient, to suggest and start the workup of the problem, to diagnose the patient and treat the disease. How satisfying!
After I didn’t see Colin for several days in a row because of my schedule, my enthusiasm waned. While the patients relentlessly rolled in, I watched the clock and counted the hours until I could go home. I was constantly hungry, tired, and missing Colin. I hoped that picking up OB/GYN patients would make things better, as I love those patients and those problems are ones I’m likely to keep dealing with (better to learn now!). But after the tenth first trimester miscarriage, I stopped fighting for those patients. As much as I wanted the patients to have good care, especially during such a potentially devastating time, I needed a break. I didn’t get one, instead starting a run of patients who’d attempted suicide. After a handful of that presentation, my emotional reserve was completely depleted. Sad situations, difficult patient issues, or urgently sick, I had no empathy. I had none left. There is only so much sadness I can feel before shutting down. The last time a patient came in with one of these devastating issues, my first thought was, “Damn, I’m going to be here forever, and I’m starving.”
Regardless of why the patient is there, be it something truly emergent or just for pain medicine, they deserve my attention and my compassion. I think that is the least of what I owe them, actually, but is a bare minimum. What does it mean that I could not even do that? I heard what they said, ordered them pain medicine or scans or fluids or whatever they needed, but I couldn’t care about their plight. I desperately needed to refill my compassion tank, but there is no time. No wonder ER doctors work shifts only 16 days of the month. Who could stand any more than that? I certainly cannot and I am counting the moments until my time is up and I can walk out of the ER for good.

1 Readers rock!:

Anonymous said...

You have defined "compassion fatique" quite eloquently.
Its hard to stay focused on others problems when they just never seem to stop.
I have to have some solitude and down time or I become a wreck.
Also celebrate those small victories.
Remember that many of us would rather have you on a bad day, than other docs on their good days!
Hang in there. I am proud of you.

Martha PJ