Editorial, Burnout

Letter from the Editor

Some days I feel like quitting.

I always imagine it happening in the same way. It will be the end of an exhausting 12-hour overnight shift. I will have just been yelled at by a sleep-deprived consultant. A previously apneic heroin addict dropped off by his buddies will now be screaming at the top of his lungs, flinging his arms wildly at the bedside nurse, calling me every name in the book. Three large security guards will attempt to wrestle him down, and I will back away slowly. The intercom will then start blaring “Don't You (Forget About Me)” from The Breakfast Club. The glass doors to the ambulance bay will fling open, the naloxone-induced uproar in the background will fade, my stethoscope will fly off my shoulders, and I will enter into the blinding light, never to return again.

While I use this example somewhat facetiously, the truth is that most of us have probably felt this way at some point in our training. And it isn't because we are lazy, weak, or cold-hearted; it is because our job is really hard. This is made worse by that fact that few people, many of whom are respected colleagues, truly understand the physical and emotional stamina required to be a great emergency medicine physician — one who must continuously operate with composure, efficiency, and grace in the setting of unanticipated chaos and uncertainty.

With this in mind, I headed into the ACEP16 Scientific Assembly in October feeling somewhat burnt out. I was tired from the daily grind — the overcrowding, the drug addicts, the night shifts, the endless interruptions, the turf wars, the malfunctioning electronic health record. One evening, after a particularly tragic patient outcome, the wheels came flying off.

I needed to refocus. I needed to feel like I had purpose, and that I could actually make a difference. After all, isn't that what called me to medicine in the first place?

I found myself re-reading Dr. Paul Kalanithi's New York Times bestseller, “When Breath Becomes Air.” For those who aren't familiar, this is a phenomenal memoir written by a neurosurgery resident who faced a terminal illness and sought to discover what truly makes life meaningful. One particular line struck me: “I remember the moment when my overwhelming uneasiness yielded. Seven words from Samuel Beckett, a writer I've not even read that well” began to repeat in my head, and the seemingly impassable sea of uncertainty parted: ” I can't go on. I'll go on.'

How was I supposed to “go on?”

That's when you showed up.

More than 1,500 of you arrived in Las Vegas in October with passion, excitement, and resolve. You spoke with leaders and role models in the field, attended groundbreaking lectures, participated in one of the most exciting Representative Council meetings to date, competed brilliantly in SIMWars and 20 in 6, brainstormed new ways to engage members within your committees and divisions, and successfully pulled off EMRA's first-ever MedWAR. To put it simply, you showed up. You showed up not only for yourself, but for your respective programs, your specialty, and most importantly, for your patients.

So why does that matter? Because the reason emergency medicine was born and thrived as a specialty, and the reason a patient who is having a life-threatening coronary artery occlusion can call 911, have an ambulance arrive at their home, be transported to a hospital, receive a diagnosis, and undergo a life-saving intervention in less than 60 minutes, is because thousands of emergency medicine physicians like you and before you, through all kinds of adversity and setbacks, awakened every day saying,
“I'll go on.”

You are brilliant, compassionate, and caring individuals with the unique privilege and honor of caring for anyone who presents through the glass doors of the emergency department at any time and for any reason, regardless of race, religion, gender, or socioeconomic status. That is so incredibly powerful and should never be minimized or forgotten.

Therefore, I ask of you: If at any point along this journey you find yourself feeling hopeless, battered, or lost, please remember this:

You can go on. Your specialty, and your patients, need you.