ER: Losing It

I've volunteered thousands of hours in the past five years on an ambulance. It began as a "prelude to med school"-- something that many pre-meds do to boost their resumes and dip their toes into the water of patient care. Most quit after they make it into med school, the utility of the operation spent. I loved it and kept going. There's nothing quite like the family at the first aid squad: a group of community members crazy enough to spend sleepless nights each week working with sick people for free. There's also nothing quite like the thrill of rushing to an emergency with lights and sirens, the fulfillment of recognizing my competence (EMT's often joke: "Somebody call 911! Oh wait-- I am 911!"), the reward of a fellow community member's gratefulness. A lot of people ask me if I want to go into emergency medicine.

I hate the ER.

I worked my first overnight (11PM-7AM) shift on a Friday. Second years had just finished exams and were out getting drunk on the street (good for them). I showed up and stood mutely at the nurse's station, unsure of what to do with myself. I was quickly asked to dance.

"You wanna go get an ABG (arterial blood gas) on this patient?"

I jumped into action! Every medical student must meet a required number of procedures before graduation, and I had yet to collect all three of my ABG's. Inside my body, catecholamines rushed to prepare me for the exploit; endorphins signaled my excitement at getting to perform a procedure. You gotta love it! I know exactly how to do an ABG. You feel for the pulse, then you stick the needle in. It's really simple. I was totally going to show my stuff.

It wasn't until I walked into the patient's cubicle that I recoiled at myself. I didn't even know who this patient was, or what she was here for; I couldn't have known, since I just started the shift. I was about to stick her without knowing her. And what gave me the right to draw her blood, anyway? If I were her, I would have kicked me out, had I known how little experience I really had with this procedure. I felt disgusted. I was using the patient.

I tried to make things a little better. I introduced myself. I acted very confident.

I missed.

I returned to the nurse's station, troubled. The tech student looked at me with pity and said, "Don't worry, you'll get it with practice," and proceeded to discuss a few helpful tips on needle placement with me. That's the truth; these things do require practice (on real people), and I will eventually become competent at them. But I felt unable to reconcile that rational argument with the feeling that I had just toed some ethical line. I stood there, inwardly searching for some source of moral solace. I didn't find it.

Instead, I got a friendly nurse:

"Hi! I'm Steve. How are you doing? Do you want to come help me take off this woman's pants?"

The woman he was referring to was a hilariously drunk woman in her forties who had just soiled herself; Steve needed a female chaperone. Taking off her pants? That's one way to meet a patient for the first time. There was also a tube top which Steve, in his male ignorance of feminine fashion, tried to remove by pulling down past the patient's hips (guys, don't try this at home; the top comes off over the head). This resulted in a lot of wiggling of the hips and peals of laughter all around. When I say hilariously drunk, I mean we all had so much fun, it should have been illegal. She's not gonna remember any of it, though.

The next seven hours continued in the same vein. I did painful stuff to people I didn't know. I met patients with bullshit complaints that I treated in 30 minutes and dispatched; I'll never see them again. I met patients with real, serious complaints that were admitted to some lucky medicine or surgery team who will get to diagnose, treat, and build a relationship with the patient over the next few days in the hospital; I'll never see them again, either. I felt like I was losing it. I felt detached, dehumanized, and demoralized. A trauma alert came in; the woman was screaming "Fuck you, bitches!! Fuck you all!!!!" and jerking all over the damn place as the trauma team was trying to assess her injuries, so they all said "fuck it" and sedated and intubated her to end the abuse.

I'm not knocking the ER for people who want to work there; it's an incredibly important job and a vital part of a hospital-- and it's not an easy job, either. But I want to spend more than 30 minutes with my patients and have time to clarify my moral boundaries. That, in a long-winded way, is why I don't belong in emergency medicine.