The Grind
Being an ER doctor isn't all fun and games. Well, it's usually fun, and mostly games, but really we're at the mercy of the city and its drunk and dying denizens. When two trauma 1's roll through the door at the same time, a scattering of chest pains and GI bleeders are still waiting to be seen in the back rooms, and the hallways are filled to the brim with gurneys... well, my heart rate starts to rise.
I enter autopilot, and start doing what I loathe the most - overtesting. It's what emergency physicians refer to as "moving the meat." It's a term I hate, but when there are multiple patients needing to be seen - any of whom could be dying - and the department is bedlam, it starts to make sense.
Chest pain? Check. How long? Describe it for me. Risk factors for cardiac disease. Labs, chest x-ray, pain control, next room. In and out the door in a couple minutes. Scribble on the chart, "typical chest pain story, patient appears well and in no acute distress, check labs. EKG nondiagnostic, will evaluate xray for pathology and admit for observation."
It becomes formulaic at this point. Patients with abdominal pain get "belly labs" and a CT. Headaches get compazine/benadryl/decadron and probably a CT & spinal tap. Traumas get "trauma labs" and a $15,000 full body CT scan to search for any hint of bleeding - it exposes them to approximately half the radiation experienced by survivors of Hiroshima.
My normally friendly bedside manner goes out the window. I'll usually introduce myself, "Hi, I'm Doctor Zac and I apologize for being brief. Unfortunately an SUV just overturned on the highway and they'll be arriving in 5 minutes, so I just wanted to pop in and see how you were doing."
I never yell, but I can be brusque. Before residency, I would have never imagined myself to be the type to say "I'm sorry, I don't have time for you right now," but it happens. At least I always say "I'm sorry" first.
I suppose it's part of being a feast-or-famine specialty. We don't have the luxury of scheduling our patients. It still leaves an unpleasant taste in my mouth when I don't feel like I can care for people the way they need to be cared for. Especially when it means spending thousands of dollars of their money that I know they don't have, and delivering enough radiation to possibly cause cancer down the road.
Trapped and Free
4:55 AM, and I was dragging. My 12th day straight in the hospital, leaving a string of three call nights behind me with one left to go. Twenty patients to see before grand rounds at 7AM.
My knee has been hurting. I suspect it's from the miles and miles I've been putting on my body 14 hours a day, 90 hours a week, running around the hospital. I've been taking the stairs everywhere in an attempt to remain in better shape, but this morning it was too much. No coffee yet and too little sleep. I gave in and took the elevator from the 3rd to the 11th floor.
I leaned back in exhaustion against the side of the elevator, eyes closed. It whirred into life, and I let the tug of gravity pull me to the ground. The elevator reached the top floor and *dinged* quietly. I stirred, mentally preparing to start rounds.
And then, the door made a few feeble attempts to open, and quit. Servos whined to a halt. I was stuck in the elevator.
Funny, how things can change. Any other time I would immediately panic. What if I have to go to the bathroom? What if the cable breaks? What if the call button doesn't work? What if I can never get out?
Instead, pure, unabashed relief washed over me. I couldn't work while trapped in the elevator.
Zac, why haven't you finished rounds yet? The situation played out in my mind, There's so much to do today! We have to get on it!
Sorry sir, I quietly replied, I'm physically trapped in the elevator on the 11th floor, there's really not much I can do from here.
Well, I suppose you've got an excuse then. Take the day off.
I sat there for a few minutes, relishing the solitude. I planned out my entire day of rest, mapping out every delicious hour I would spend in each corner. Perhaps I'd take a nap right in the middle of the floor. I smiled. It was going to be a good day.
Then the elevator *dinged* softly again, and my hopes sank as I traveled back down. The door opened on the third floor. A tech stared at me in surprise, papers stuffed in my pockets, hair askew, sitting on the floor of the elevator.
"You alright, man?" he asked.
"Not really", I responded. I stood up, knee hurting, as I limped off towards the stairs.
The Endless Tide Of Unwashed Humanity
Faceless children throng through the doors of the Peds ER; parents, illnesses, charts all flowing into one feverish, runny-nosed amalgamation.
The waiting room is full of these kids. Anyone who didn't have the flu before, does now. It takes 7 hours to be seen, plenty of time for snotty hands to wipe all over the tables, the chairs, the playthings.
I vaguely listen to my voice on autopilot, droning on about the benefits of motrin and tyenol for fevers. I'm surprised to hear myself lose patience with a particularly insistent mother who wants her daughter hospitalized for a fever of 101.3 and a cough. Her kid is fine. She won't take no for an answer. We get security to escort her out.
This isn't fun. At one point I see 8 children in a row who I diagnose with the cold. The monotony is broken by a child with a cut on his finger, but he starts screaming the second I enter the room. We have to sedate him before I can sew it up. He hates me for it, and his mom judges my repair every step of the way. I look too young, she explains. My next 5 patients all have the cold. Nothing about this is enjoyable or fulfilling.
The shift ends with a whimper, as we finally clear out the waiting room 15 minutes before I'm scheduled to leave. My last patient is a kid with a cough. I send him home with tylenol for the fevers. The parents can't believe they waited eight hours for me to tell them that. I can't believe they did either.
Apathy
Well, it's struck again, the dreaded apathy.
It's interesting, as I look back through my med school career. At first I remember being totally excited to learn, to understand, to really study our coursework. Anatomy, neurology, physiology... that was the stuff I loved in college, and being able to study it and apply it to other people? What an honor, what a privilege!
The grind slowly caught up with me. I studied too much, took the "work hard, play hard" mantra too much to heart. I would sit on the couch with a beer, a sleeping pill, the TV blaring, and my computer fired up simultaneously just to relax. I started making jokes that I used coffee as an upper in the morning and beer as a downer at night... but I wasn't joking.
I finished Boards - god knows how - and thought to myself finally the long hours, the stress, the constant feeling that I should be doing something productive would stop.
3rd year rolls around and you realize that for all the studying you may have done during years 1 and 2, you still don't know shit. Attendings pimp you on arcane knowledge from their specialty they've been practicing for 40 years and are shocked when you don't know it. End-of-rotation exams are brutally hard and require you to diagnose, treat, and manage 100 patients in about 120 minutes.
On top of it all is the knowledge that everyone you work with... interns, residents, attendings... are all going to grade you subjectively on how well they thought you did. So you put on your smiley face, pretend like ophthalmology is the most awesome field EVER and go to work every morning, starting on average at 6AM and finishing around 5PM.
It is brutal, and exhausting, and sometimes honestly I wonder if it wasn't a huge mistake to go to medical school. I'm not asking for sympathy here, by the way, but instead hoping that some of you nod to yourselves while reading this and go "yeah, I know where he's coming from. I've thought the same thing to myself from time to time".
Listen, sometimes you get that patient who comes along and just makes it all worthwhile. But sometimes you punish your body, mind, and soul for some asshole who treats you like crap and expects you to FIX EVERYTHING WRONG WITH ME even though he's not fixable.
I'm a person too, folks. I like sleep, and food, and friends, and family. I've lost a lot of that these past 3 years... and sometimes the field of medicine just isn't rewarding enough to make the sacrifice worthwhile.
I suppose the reason I write this now is that I have really, really been enjoying internal medicine- I like the diagnosis, the management, the primary care aspect. But I see my interns and residents getting no sleep every 5th day (and if you aren't a meddie, imagine that for just one second. No sleep every 5th day for the next 4 years of your life... plus little sleep the rest of the time) and frankly, I don't know if I want to do it.
So, here I am again, thinking about the decision between doing what I love and doing something where the lifestyle doesn't suck. There's a damn good reason people go into pathology, anesthesia, radiology, and dermatology. You work real people hours, and you get paid a decent salary.
After all this time and energy, don't you think we deserve that?