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I have a confession to make. I love my job. I’m often afraid to admit this out loud. I look forward to going to work in the ER and miss it when I’m away.

Why do I feel so alone? Is there something wrong with me? Whenever I’m with a group of colleagues, all I ever hear is complaining. Last week, one of my colleagues was actually banging his head on the counter top and repeatedly hollering, “I hate my job, I hate my job!” Of course after ranting and raving about how miserable it is to work in the ER, the discussion always turns to alternative lifestyles. “Why couldn’t I have become a dermatologist, radiologist, attorney, etc...”

Working as an emergency physician (EP) is the greatest job in the world. As my 9-year-old son states with glee, “you actually get paid to look at naked people and gross stuff. Most people pay to see that!”

In his entrepreneurial nature he also calculated how much I get paid to have a bowel movement, since I’m paid the same for every hour I’m there. (It’s $12.75 for a five minute BM). My son advised me never to poop anywhere else.

What EPs do is great. Anyone. Anytime. They are the safety net for the health care mess. I am proud to be part of that. Multiple times a day people ask me for my help. Many days I save lives. All days I ease suffering. It is what other people dream of doing. There is a purpose in my life.

In addition, I get paid well. It is always air-conditioned in the summer and heated in the winter. Hospital food? After eating it for over 30 years, I miss it like mom’s meatballs.

I get to listen to stories fiction writers could only dream of. “You did what with what?” “You put what where?” “Oh, that’s your partner in room 8.” I’ve learned the easy way how to avoid accidents. I have the privilege of learning through other people’s mistakes. People allow me to share the most intimate details of their lives.People say I’m not a specialist. Who cares? I get to play in the best parts of other specialist’s practice. I see more acute MIs than cardiologists, more acute CVAs than neurologists, and diagnose more appendicitis than surgeons.

Yes, I am a Jack of all trades. I’m like an old craftsman that builds a house from the foundation up. I’m the electrician, plumber and carpenter. I can do almost anything with almost nothing. There is nothing better than watching a specialist come in and get frustrated because their favorite instrument isn’t available. Need an intubation? Hand me a spoon and a flashlight.

My days are rarely the same. I don’t come in and look at my pre-printed schedule to see what I’ll be doing for the rest of the day. I just wait for it to happen and be surprised. Chaos, I love it.

Comradeship is strongest in the ER. No where else do physicians work as closely with nurses and techs. It’s like one big dysfunctional family. Extended family, like EMS, is always dropping in unexpectedly, but we always make room for them. Sometimes when I’m off duty, I like to sit there and watch everyone work. Somehow with all the chaos, things still get done. It’s like watching an ant colony. The ants are going in all different directions. Before you know it, a giant ant hill arises. With the pride of a father watching his child take that first step, I watch the team of physicians and nurses stabilizing a trauma patient. At 4 a.m., with weariness growing heavy, people say things they wouldn’t tell their spouses. The experience of humanity is brought to its peak in the early morning hours of the ER.

Rotating shifts? Bring them on! I get to drive against traffic, see sunrises and sunsets. I get to smell the early morning air and feel the late night excitement. I get to go shopping when the stores are empty and take advantage of matinees. The gym is rarely busy at 2 p.m. on a weekday. One of my favorite things to do is go out on the ambulance deck late at night and see the snow on city streets before its been disturbed. And I love the smell of diesel on cool misty mornings.

No, I don’t make as much money as some of the other specialties, but I make more than others. Right out of residency, my starting pay was close to my senior partners. I did not have to spend years to build up a practice. I can leave my position anytime and move anywhere without much of a loss in benefits or pay. Colleagues in other specialties are stuck where they are. To them moving means starting all over. If I want a new refrigerator or wide screen TV, an extra shift in some sleeper ER will more than cover it.

Don’t forget the regulars. I would miss them. Why complain when they come again and again? They’re like regular customers, the black sheep of the family who show up at the most inopportune time. Most call me by my first name. The chronic back painers, alkies and homeless. You don’t want to see them every day, but when they don’t show for a while you hope they’re OK. Like Otis Campbell, the town drunk in Mayberry RFD, the regulars are annoying but lovable.

There is always free education available in the ER. I am a perpetual resident, constantly consulting and receiving instructions from multiple high-classed specialists. Some see it as doing their scut work. I see it as receiving one-on-one tutoring. I have often been talked through procedures over the phone to keep the specialist from coming in late at night. Most physicians pay big money for that type of CME. I get paid for it.

When I talk to non-EPs, they all have stories of how they moonlighted in some ER early on in their career. These are proud stories of the romance of being all alone in the ER, saving lives. It is talk of the good old days.

Of course, there is never any regular schedule in the ER. Weekdays, weekends, holidays– they don’t matter. The ER doesn’t stop. This has brought closeness in my family life. We have learned that the importance of a holiday is being together. It doesn’t matter what day it is. 4th of July on the 5th, the fireworks are just as bright. This was really brought home this past Christmas. My two daughters who are grown and living on their own showed up with their respective beaus, two days before Christmas. They were all ready to celebrate a little early, as has been our routine. I didn’t have the heart to tell them I was off on Christmas this year. It makes it easier on the in-laws.

Being an emergency physician has given me many gifts. It has allowed me to share in the most private, sometimes dark areas of other people’s lives. It has taught me the fragility of life and encouraged me to make the most of every minute. Which reminds me, I can’t wait to get back to work.

Mark Plaster, MD will return to Night Shift in May.
 

Comments   

# M Greenberg 2009-04-01 00:37
It is nice to know I am not alone.
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# B Gold 2009-04-03 11:16
You just embodied all that I love about this job. There is no other place in the world like the ER. I LOVE THIS JOB.
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# Hope...C Johndro 2009-04-04 01:21
After a long week of Neuroanatomy exams as an OMS-1...this story helped me re-focus on the "big picture"...the love of medicine, medical family (RN's, EMS, etc..) and good times to come (someday!)...Th anks for sharing...Regar ds, Charles (VCOM 2012)
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# Great articleTammy 2009-04-04 17:39
Great article , Joe. Why I stopped being a hospitalist and made the switch to EP. Tammy
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# Katrina Wade 2009-04-06 02:11
Excellent and entertaining. Joe, I never figured you for someone that would crack me up so much. Nice job!
Katrina
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# Took the words out of my mouthDorothy 2009-04-06 03:44
I tell everyone that I'm one of the luckiest people in the world. I don't work for a living...I look forward to going into the ER everyday I have a shift for the reasons expressed in this article. It's the best job in the whole world!!! I haven't worked a day in my life since I became an EP! And look at the difference we make in people's lives! Thank you for expressing it so eloquently!
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# Great column, Dr DeLucia!Michael Garrett, M.D. 2009-04-08 00:59
What a breath of fresh air! This was a delight to read and you make many excellent points. Thank you, Dr DeLucia.
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# MD/MBADr. Kerry Forrestal 2009-04-09 16:52
Very well done sir.
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# worlds most experienced ED physician ?Carl Shirk M.D. 2009-04-12 08:06
Beautifully written! Thank you for reminding me why I keep doing this. my children suggest it is a form of insanity. To me it is a marvelous revelation of reality. After nearly 50 years I still look forward to my next shift and leave savoring the last one. A spoon and a flashlight, delightful, we are all still learning.

p.s. my wife is usually the first to read Night Shift and gives me a synopsis, she will love this one
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# A Kindred Spirit!Phyllis Chen 2009-04-13 05:17
Thank you for putting in to words how I feel(except about the hospital food :-) ) about being an EP, and how appropriate that you wrote the “Night Shift” column as it seems that it is overnight that all the attributes that you ascribe to our passion are magnified/inten sified: the interesting cases, the chaos, the revelation of poignant reality with all its pathos, and yes, the camaraderie. Next time someone asks me why I love to work nights, and so many of them, I will send them a link to your wonderfully written article. Thank you Dr DeLucia.
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# Joyce Rosenfeld 2009-04-13 12:51
Great article.
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# Well Done!John Kerns, DO 2009-04-13 14:15
I thoroughly was entertained and refreshed by your article.
I couldn't have said it better. Those are the same feelings I have, even after doing this work for 20 years! I feel very blessed that I love going to work...still feel like I occasionally impact indivduals lives positively.
I frequently tell my non-medical friends, "there is no feeling in the world like knowing an indivual is alive tonight because of decisions and medicines that I gave in the ED today"!
Well done!!
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# MDMelissa Lynch 2009-04-17 21:28
Love, love, LOVE your article. I'm printing it out to save and re-read on one of my bad days. Thanks!
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# Much needed refuelingMisty Navarro 2009-04-17 22:11
Thank you for your article. After a particularly difficult shift its nice to have a reminder of why I do this.
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# M.D.Jim Eliason 2009-04-18 14:59
Well said, Joe! What an eloquent reminder that we really do have a great job. Thanks for the encouragement.
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# Love it!Laura McPeake 2009-04-19 17:24
Great article, someone finally understands and can put it down on paper!

I will share it with my coworkers and friends.
Thank you!
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# ER TechAngela koum 2009-04-23 06:17
Thank you for putting together the many reasons we all "Love our job" in the ER even when we say we hate it. We all share the joy of saving a life, the pain of loosing one, and the many stories of our regulars. One time we asked the EMT to check on a regular we didn't see for 5 days since for a year she was coming almost everyday, sometimes twice a day. That just show how we get attached to the people we see in the ER.
Thanks
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# Bulls-EyeJohn Dallara 2009-04-23 18:44
Joe, congratulations . You have given voice to why we EM physicians love what we do, and who we are. This should be required reading for all physicians who aspire to be ER doctors. If you a smiling at the end of this piece, then you have "the right stuff".

John Dallara
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# s frankel 2009-04-28 23:19
right on target.
i shared this with several friends who dont understand 'why i do what i do'
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