Vacation serves as a reminder that life as an ER doc can actually be pretty fun once you escape the emergency department.  My conference was in a beautiful location at a posh hotel where I met and exchanged ideas with all sorts of nice, interesting people.  Thanks to two years of attending-level paychecks, I didn’t have to sweat every meal out or sight seen.  I came back feeling rested and energized.

Which lasted for all of about 15 minutes into my first shift back.  That shift is always one of the toughest, I think, because the contrast between a relaxing vacation and the chaotic ER is so jarring.  I constantly felt a step slow, everything that could go wrong did, and I left basically wanting to pull my hair out.

Working serves as a reminder that there’s plenty to not like about my job.  I find it stressful.  It’s not one thing that gets to me, it’s like someone has a BB gun and is continually firing little stress pellets at me.  Pow pow pow, it’s the cumulative effect on any given shift of being short-staffed, or having no open beds upstairs, or lab running slow, or orders misentered, or computers going down, or consultants not calling back, or irate family members, or no ingles, or waiting forever for CT reads, or seeing the waiting room fill up, or being peppered with literally hundreds of questions throughout the day, or a general feeling of being pulled in too many directions that wears me down.

Not to mention the patients.  The standard pre-med response to “why do you want to be a doctor?” is “because I like working with people.”  Only now do I realize how inane that is.  Saying I like people is as generic and meaningless as saying I like food.  Some food I like alot, but plenty of it is downright nasty, and unfortunately the ER tends to attract the balut of humanity.  Personality disorders, psychotics, malingerers, drug seekers, and drunks abound.  Patients make outrageous demands.  Family members tell you how to do your job.  Even normally reasonable people can have the worst brought out in them by the general stress of the situation.  There are likeable folks sprinkled in, but plenty more who are not much fun to be around. 

My favorite part of this job is that I get a lot of time away from it.  And as everyone knows, it’s going to get a lot worse before it ever gets better.

Still, work has its moments, some more dramatic than others.  A long time ago I took care of a little girl with intractable seizures because of head trauma with a significant brain bleed.  I intubated her, stopped her seizures, got her through the scanner and had her flown to the nearest children’s hospital where I assumed she would die.  She didn’t though, instead she somehow managed to make a miraculous recovery I recently learned when she came back to my ER this time for something completely benign.  It was busy and she wasn’t even my patient but I didn’t care: I spent some time with her and her mom because, you know, if you can’t soak up this moment then what’s left?     

Power through work until the next stretch off.  Try to focus on the good and play down the bad.  I hope I last for 20 years or so, because I really don’t have a plan B.