I'd like to take a moment to thank the field of Emergency Medicine for something I hold very dear: scrubs.
Wake up, throw on a pair of glorified pajamas, and roll into work as an acceptably dressed physician? That, friends, is awesome.
I got asked this question at a dinner party the other night: "What's the difference between emergency physicians and other doctors?"
It took me a moment. I haven't had to answer that question since interviewing for residency, back when I had only spent two months as a medical student rotating through the field. I think I've got some better answers and perspective now. So, for all you aspiring premeds out there , or for laypeople interested in just what makes an ER doc tick...
1) You have to have passion for what you do.
This is true for every medical specialty, but moreso in emergency. A 10 hour shift will run you ragged and exhausted. It's only because I love it that I leave my shifts in a good mood. I helped a couple people, saw some cool things, and sure I'm tired... but at the end of the day I did good work.
2) You have to be willing to roll with the punches.
Usually figuratively. Sometimes literally. Things will be thrown at you that you would never expect. Multicar pileup on the freeway? You bet all those patients are coming to you at the exact same time. Guy found unresponsive in the snow? Yup, take him to the ER. And somewhere in there, a heart attack will sneak on through. Naturally they all arrive without any medical records.
3) You have to love interacting with people.
The emergency department thrives on teamwork. If you're not a people person, or you can't take criticism, you're dead in the water. You live and die by your nurses, techs, and consultants. Plus, you've got all of 5 minutes to meet a patient you've never seen before, shake their hand, and gain their trust so you can figure out what's wrong with them.
4) You can't be offended easily.
Consultants hate being called by the ER. Yeah, they're "on call", but I assure you nobody likes to be woken up at 3 AM. You'll be questioned on your medical judgement, you'll be ridiculed, and you need to understand that the other person is just tired. They simply don't want to see the patient if they don't have to.
5) You need to be quick on your toes ...
Slow people don't typically enjoy emergency medicine. If you don't like the idea that multiple new patients could show up at any time and need to be seen quickly, you may want to consider a specialty where you have time to be methodical, triple-dot your i's, and extra-cross your t's.
6) ... and good with your hands.
You hear this about any field that performs procedures. You will do so many procedures in emergency medicine that you will stop counting - and you will be grateful that you like to work with your hands. Some people simply don't enjoy this.
7) You need to accept your limitations.
You will never be a cardiologist, nor a neurosurgeon, nor a radiation oncologist, so you will not understand everything that they do. You will, however, know about 70% of what they do, which is just enough to babysit patients until the specialist comes.
8) You have to keep an open mind.
Our patients can be very hard to deal with. Suicide attempt by swallowing one tylenol. Alcoholic presents for acute missing sandwich and stat hot shower. Drug seeker needs dilaaa... dilauudaaa... dilaudid, is that it? The earlier you learn these people truly need help - referral to detox centers, shelters and social work, the easier your life will be. Otherwise you will turn into a cold shell of a person, always suspecting someone is trying to get the best of you.
9) You've gotta enjoy a bit of chaos.
For some, fun is a nice round of golf with the chaps. For us, fun is when the ED goes batshit - every patient wants something, every nurse, tech and doc is overworked, yet somehow you're keeping it together. It's trench medicine. It's the front lines of the American Health Care Debacle System. Exhilarating, isn't it?
10) You should be proud of what you do.
The unwashed masses are cast against the shores of the department and you take all comers. You don't ask insurance status. You don't ask if they can pay. No, you treat meningitis, fatal arrhythmias, broken bones, and bring people back from the brink. Why? Because it's the right thing to do.
After my interview I head back to the hotel, change into more comfortable clothes, and take a stroll around town. Street jazz bands play while the warm breeze gently caresses the city. People take it slow down here in the South. Today during the interview a woman stopped our group, "Y'all should know I'm the survivor of a pul-mow-nary em-bow-luss. Thanks to God Almighty and to y'all wonderful doctors, I'm still here today to speak with you. God bless". And she continued upon her way, a smile on her face.
An Irish pub with cheap Guinness beckons, and I sit at the bar with a few NASCAR fans. One offers me some chicken tenders, which I politely decline. Eventually the conversation turns round to jobs. The guy next to me, Budweiser in hand, with a flannel shirt and a trucker hat, speaks up.
"So, buddy. What brings you all the way out here from the southwest?"
Slowly, drinking my beer, I reply. "ER residency, actually. Your hospital out here is one of the best in the nation."
"Now, that's a job I can respect. Me, I roof houses." He pauses, catching a quick glance at the cars flying around the track. "You seen people die? And there ain't nothin' you can do about it?"
"Yep," I reply, "it can be pretty rough."
"So what makes it worthwhile? I think I'd up and quit the first time someone died on me."
I pause. This is the most honest question I've gotten on the interview trail, and it isn't from an attending, a resident, or a program director.
"I suppose," I slowly say, "I suppose it's when you can help people that makes it all worthwhile. When you can look someone in the eye and tell them they'll be ok."
He smiles quietly, as though I said just what he expected to hear from a doctor in the making. I smile too. We clink glasses and toast, then sit back and watch the cars race around the track in comfortable silence. This is a good place for me.