I pressed myself into the corner of the seemingly tiny hospital room in the trauma bay of the Emergency Department. Someone was shouting but I couldn’t hear the words. Everyone was rushing. You seemed larger than life in the hospital bed. Your heart stopped sometime ago but we worked to get it beating again; at least long enough for your family to say goodbye. You still weren’t breathing on your own. I was there for job training to be a scribe – I wanted to be a doctor. My applications were in. I just had to wait. This was the first time I had seen ACLS in action. I couldn’t take everything in before we were rushed out to see the next patient. What was I supposed to document?
Your “friends” dumped you outside the ER. You were my younger sister’s age. We tried to bring you back for 45 minutes but you were gone before you got here. By now I’d been scribing for several months. I had a medical school acceptance letter. As I did my job I tried to soak up every bit of medical acumen I could before I went to school. I’ve seen ACLS many times now. I watched the physician desperately try to bring you back. I watched her tell your grandmother you were gone. I watched her gather herself in an instant and move onto the next patient.
You fell down an elevator shaft at work. 20 stories. At least that’s what I heard. I’m a third year medical student on my surgery rotation now. We catch the trauma cases in the Emergency Department. I marvel at how you are even alive. After everything I’ve learned, the human body still amazes me. I’m able to assist in patient care now, even if only in small ways. Cut clothes, hold pressure, hand over gloves. You have so many fractures, so many injuries. But you’re stable. To the OR.
As I enter my fourth year of medical school I can easily recall a few emergent patients whose stories stand out. The first time I saw chest compressions. The young patient lost to a drug overdose. The construction worker who fell and shattered his bones. You never really know what you are going to see from day to day as a medical worker – especially in the emergency department. So how do you prepare yourself? One could argue that you can’t. You can’t prepare yourself for the patient that reminds you of your beloved grandfather. You can’t prepare yourself for the unforeseen tragedy. You can’t prepare for the unknown. However, you can practice self care. When someone comes in to the Emergency Department in critical condition everyone moves swiftly and efficiently to stabilize and move them to the next phase of care. At best it works like a well oiled machine. There is often not time to process while working. However, once the patient has moved on, take a moment and breathe. Acknowledge the work that you did. Ground yourself in the current moment. Go on to the next patient.
Self care varies from person to person but includes sleep, talking, hugs, exercise. Many in the medical field argue they don’t have time for such activities but I argue to make time. I cannot emphasis how important it is to debrief after tough cases or find some other form of catharsis. You cannot provide your best patient care if you yourself are suffering. Emergency medical care is especially difficult I think because we are dealing with other people at what may be the worst day of their lives. Or the last day of their lives. It wears on you to see this day after day. Not taking care of yourself before and after this work is a mistake. You have to find what works for you and stick to it.
Emergency medicine is not always sorrowful. Sometimes you are able to give someone joy back. You start life support and get someone back! You get to tell a family their loved one will be alright. Not all tears in the Emergency Department are sad. These happy moment help with the tough ones that’s for sure.
For me, as I prepare for my last year of medical school and my future as a physician, I’m still working on my self care routine. Even after all my schooling and training and working in the Emergency Department as a scribe it is still not easy to watch a life be lost. Successful life support efforts still put a certain stress on one despite the great reward they bring. As I walk into each shift at the hospital I remind myself anything can happen and I can only do my best. When I leave the hospital I spend a little time on myself to make sure I handle the stress of the job. In the end, when someone rolls in through ambulance bay doors all I can do is take a deep breath and –