div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;""Small Victories"/div
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div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" I've been fortunate enough to help train some of the most amazing minds in Emergency Medicine, and I've worked along side incredibly endearing EM colleagues in both academic and private arenas. I've seen many personalities come and go, but lately I've noticed a trend in recent graduates. There seems to be no shortage of disillusioned medical blogs decrying the fall of the medical era. I call it the residency "let down."/div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" I remember feeling as if something would miraculously change once I completed residency. I chose EM to aid the helpless, and treat the downtrodden. I wanted to be there for people when they were undergoing their worst moments in Life, but in residency there seemed to be so many obstacles in caring for "my" patients. I knew once I finished, however, things would be smoother, and I would feel as if I could truly make a meaningful impact. The goal we all reach for after years of study and sacrifice was finally upon me, and yet when I showed up for work on July 1st as a newly minted Assistant Professor (a whopping 16 hours after completing my last shift as a third year resident), I felt nothing short of disappointment. There were no imbued powers with my staff ID badge, hospital beds didn't magically appear, answers to complex clinical questions never materialized without effort, and the brand new third year residents simply knew me by my first name./div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" I didn't expect to be treated differently, but I had hoped the stress and fear of the unknowing would melt away. If anything, they were amplified. Now I was responsible for teaching young(-er) medical students and residents. When the complicated airway or the central line fiasco presented itself, it was up to me to find a solution. Embattled social admits, with seasoned and somewhat jaundice hospitalists, chipped away at my zeal, and the apocalyptic interactions with radicalized 2nd year trauma residents made GSW's and MVC's less appealing. Patients continued to make poor personal choices like buying tobacco and iPhones instead of Lisinopril and Metformin. They failed to follow up in clinics for appointments we so painstakingly arranged, and they continued to "lose" their Norco prescriptions. Over the years, I found myself wondering why I chose medicine let alone Emergency Medicine. I was even considering going into another specialty./div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" Who can possibly blame recent graduates for feeling the same? As EM docs, we live chest deep in the muck and turmoil of vulnerability and violence. We "manage" the listless liars, drunken derelicts, intoxicated ingrates, and engendered entitlements. We stumble through metrics, satisfaction scores, and unruly consultants. We tend to the putrid underbelly of a raucous humanity, and once our shift is over, we try to stuff our visually impaled memories deep into compartmentalized catacombs. Conceptualizing another 20 to 30 years of this Machiavellian matrix can be paralyzing if not disheartening. Where is the sense of purpose when all you see is a revolving door of disappointment?/div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" I worked with doctors who smiled every time they showed up to work. They laughed and shared their interesting cases as if the Nobel Prize of medicine was breaching the horizon. They weren't drunk (as far as I knew), but they were happy with their path in Life, and they found their sense of universal meaning. I wondered why, and more importantly, I wanted to know the secret. I listened intently when they taught other residents. When I would find some solace in the occasional CPR save, they were giddy with the urgent care bread and butter. The stubbed toe, the runny nose, and the splinter were sustaining them in some way. I observed their interactions with patients who frequented our ED's for narcotics, and the patients would leave satisfied without pain medications. These "wonder docs" seemed to be "troll whisperers", and they would stroll onto the next untoward social disaster as if they just bonged fifty espressos through a short straw. What was I missing?/div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" One morning, I went to examine a young woman who presented with abdominal pain. She was newly pregnant, and had suffered multiple trials of IVF. I could see the fear in her blue eyes, and then slowly as I explained to her that this pregnancy too was failing, the fear blurred behind waves of soulful pain. I sat down, and let her cry. I didn't say a word. I just listened and waited. I had counseled thousands of patients with bad news. This shouldn't have been any different, but it was. I felt like I needed to do something more than just give "abdominal precautions", so I took a chance. I reached out to her hand, and told her "It's not your fault." She lost it. The nurse came running in wondering why her patient was sobbing, and she reached for some tissues./div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" The patient looked up, and I thought she was going to say something like "Thanks, idiot…", but she didn't. After all the months of constant lab draws, hormones, and emotional pendulum acrobatics, no one had taken the time to absolve her of any guilt. She was told her FSH/LH, and progesterone levels were not right. Her endometriosis was a huge hurdle, and her last few miscarriages suggested something genetic was at play. All of these things suggested to her that she was "broken". She could only infer that it was her fault, and all this time, she continued to blame herself. Here I was, a "too young to be so jaded" EM staff, and this patient took my hand, and said "Thank you."/div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" I went home that day, and my mind consistently perseverated on this patient encounter. I didn't analyze the awake intubation we performed that day, or the STEMI that we rolled to the cath lab in 30 minutes, but I remembered her saying "thank you." Something clicked. In that single moment, I realized, all this time, I had forgotten to celebrate the small and simple victories. It wasn't enough to only focus on the "life saving interventions" because those are truly few and far between. I had to start paying attention to the "little things". I figured that was why the "happy docs" found satisfaction in the ED mundane./div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" Now don't get me wrong. People who know me will tell you I'm the last person to snort rainbows and drink sunshine. This change of my perspective didn't happen over night. It was a long process of peeling away years of greyed, calloused compassion. I consciously sought out the small "wins" on every shift. Sometimes it was simply listening to a WWII vet's stories, and saying thank you as he left for his inpatient oncology bed. Other days it was smiling back at the asthmatic kid who emphatically waved goodbye because this time he avoided another hospitalization. It was getting my colleagues to laugh at one of my dumb jokes, reminiscing with the nurses about my days as an intern, and seeing the light bulb go off in the second year resident's eyes when they floated their first intravenous pacer. I had somehow discovered a novel way to find fulfillment in EM./div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" I would never be naïve enough to presume that anyone unhappy with EM right now could simply melt it all away with hand holding and thoughtful meditation. Emergency Medicine is hard, and I still have my bad days (just ask my wife). In the ED, we see and do things that no one should ever have to experience, and we're the ones who stand within the void when all seems lost. We shoulder much of what society has no answer for, and we succumb to self-doubt just like everyone else. The challenge I offer up for you, if you happen to walk through your shifts like a hapless stoic, is find the smallest of victories every day. Seek it out with every patient, family member, and colleague. Celebrate the common, and commemorate what you may presently think to be unimaginative. Emergency Medicine will never be the red-hot passion you feel for a 1968 convertible mustang (or a Maserati Quattroporte GTS). It's the warm, worn, winter coat you reach for first, every time you step outside into the erratic Texas weather. It would never stand out on a coat rack, but it fits, and you wouldn't have it any other way./div
div dir="auto" style="color: #222222; font-family: arial, sans-serif; font-size: 12.8px;" Last year, I was getting groceries at our local HEB. I heard some God awful screaming behind me at the checkout aisle. I turned and looked, and there were two crying infants, twin girls in fact, with Nordic blue eyes. I looked up, and it was the same lady with the miscarriage I had seen a few years back in the ED. She didn't recognize me since I was about 30 pounds lighter and had a full-grown beard with way too many grey hairs. I didn't want to be the creepy old guy staring at the new mom and her kids, so I looked away. She apologized for the loud wailing that would put any worthwhile Highland banshee to shame. I smiled and said "no worries". I packed up my groceries, and all the way home I couldn't help but think about those two "small victories". -csc/div