It was to be my last shift in the ER for about a year, so I was feeling a little reflective. Oh, don’t get me wrong, after 15 years as a locum tenens physician, I was familiar with the feelings that go along with detaching from a good staff. But this was a little different. I had a right to feel a little uneasy. I am going back to Iraq during a period of fragile stability. And I’m not sure what to expect as the Iraqis watch the U.S. prepare to do political combat this fall. Denver might turn into a fight that spills over into Baghdad. But that wasn’t really what was coloring my thoughts. It was hard to leave the staff. I was ‘part of the crew’ now. Albeit as a minor player, I still feel like this hospital is my ‘home.’ And I’m needed here. Right? Well yes, and no.
As I cruised through the ambulance bay doors, I was greeted by a warm welcome from the clerks. I caught myself checking the ‘To See’ rack first, to see what kind of night it was going to be. Two attendings, a PA, and a resident were all too busy seeing patients, discussing cases, and writing notes to see me come in. I just slipped into the chaos, grabbed a chart, and signed into the computer. To the uneducated, or inexperienced, stepping into this scene could be considerably unnerving. But to me, the noise, the smells, the rhythm had a certain comforting familiarity.
My previous shift had ended with the wild, extended, but successful resuscitation of a 55 year-old in cardiac arrest. What would tonight bring? I felt like an athlete entering the game for the first time that night, or a pianist sitting down to tackle a complicated concerto. After the first hit, the first note, all the jitters left and it was all business.
The first patient was in respiratory distress. MI, CHF, COPD, PE or all of the above. After quickly introducing myself to the anxious family I settled down to ‘work the problem’. Before long the patient was improving, the family was relaxing, and I was moving on to the next crisis. Multiple diagnostic and treatment algorithms were moving through my head simultaneously. I felt like I was at the top of my game.
The next patient was pure finesse. She was a cute little two-month old whose mother claimed wouldn’t stop crying and “won’t eat”. Sepsis? Respiratory distress? Maybe, but probably not. I took the baby in my arms, got some warm formula, began swaying gently as I spoke to the mother, and before long the infant had, to the mother’s amazement, downed several ounces of formula and fallen asleep. So sound asleep, in fact, that I was able to perform a thorough exam. While pushing on her tummy, she passed gas, burped, then smiled in her sleep. I handed the baby back to the slack-jawed mother and simply said, “I think she’ll be fine, ma’am.”
It was like that all night. Good cases, great staff, successful outcomes. Even our regular drunks stumbled in and out without complaining, peeing on the walls, or cursing at the staff. As seven o’clock got nearer it looked like it would even be a clean turnover.
As I made my way across the gradually filling parking lot to my car, I stopped to admire the beautiful sunrise over the Chesapeake Bay. Then I realized something. Just as the sea rushes in to fill a void, life in the ER would do the same. Another physician is taking over where I just left off. And another physician would work the following night. The ambulances will keep lining up. The waiting room will just fill up again. Profound, huh? By now you’re probably saying, “I knew those night shift guys get a little nutty by the end of their shift.” But seriously, think about it.
We are, at the same time, both fungible and irreplaceable. Fungible in the sense that someone just like us, with similar training will step right in where we left off without missing a beat. So we should never think ourselves too important. Throw a fit over some silly issue and quit your job, and there will be somebody to take your shift. It might be tough for little while, but I’ve never seen an ER close because somebody decided not to show up. But we are irreplaceable, too, in the sense that we are linked together. And the whole safety net is only as strong as its weakest link. We are humbled by the somewhat anonymous role we play in the endless stream of patients and care. And at the same time, we take great pride in being a part of something that is the front line in the fight against disease, suffering and death.
“Are you only taking one spare uniform?” my wife asked as she sipped her coffee and watched me pack my sea bag. “You’re going to be gone eight months. Aren’t you going to get tired of wearing the same thing?”
“I’m going to a combat zone, sweetheart, not a fashion show,” I mumbled, still packing methodically. “Besides, that’s all I need. Wear one, wash one.”
“That’s what I mean,” she said. “All you guys look exactly alike. All the Marines have the same hair cut, same clothes. All the same drab colors. Wouldn’t you like to wear something different sometime?”
“Honey, that’s why they call it a ‘camouflage uniform’,” I said pedantically. “We are all supposed to look alike. We’re supposed to blend in. I don’t have to be unique to be proud of who I am. I’m proud of what I’m a part of.”
“Yeah, but wouldn’t you like to stand out some time?” she said with a dramatic flare. “What if your uniform, instead of that drab brown, was a pale, spring pink?” she said dreamily.
“Very funny,” I said going back to my packing list.
Then there was a long pause, followed by a knot in my stomach. “Oh no,” I moaned. “Oh no,” getting louder. “Honey, please tell me you didn’t wash my uniform with that red towel.”
She looked at me and grimaced.
Mark Plaster, MD
Founder & Publisher of EPM