Editorial, Burnout, Wellness, Compassion Fatigue

Wake-Up Call: Fear and Empathy in Emergencies

The shrill sound of my pager rang me out of my early-morning stupor at 5 a.m. The small screen indicated that a Level 1 trauma was heading our way soon – this overnight shift wasn't quite over. Near the end of my month long rotation with the trauma service I was tired, hungry, and hoping to get off on time at 6 a.m., for once. I groaned back at my pager in response as it beeped. Semiconsciously dragging my feet a little, I walked into the trauma bay. Just a handful of minutes earlier that morning there had been a single-vehicle crash involving a young adult male. The tele-EMS report stated that he may have fallen asleep at the wheel, veered off the road, and struck a tree. He was unresponsive and intubated on-scene. I was scribing for that particular case, so I positioned myself off to the side of the room in preparation for the patient's arrival. We waited for about 15 minutes. “Why can't they ever estimate the correct ETA?” I complained to myself.

The EMS crew finally arrived with the patient, who was immobilized, intubated, and being bagged. I caught a glimpse of the man from the side, through the arms of the many ED nurses and techs who had gathered to unstrap him from the backboard, cut off his clothes, and hang bags of IV fluid. His face was young and handsome. Several days of stubble covered his square jaw, and it was accented by neatly trimmed brown hair.

It was at that moment that I registered my husband's face.

I could not move. Frozen in shock, I remembered that he always awoke early at 4 a.m. and drove to work at about this time. I pictured him tired, nodding off, then falling asleep at the wheel, and finally crashing violently against a tree. I pictured him lying on the side of the road in the early-morning fog, lifeless. I pictured him helplessly being intubated by the paramedic. My heart sank. My head felt light. I was suddenly flushed, and my knees almost gave out. “Do something,” I said to myself, but I could not.

I walked only a single step closer and the face of my husband mercifully faded away and became the face of another young man, so similar in appearance that I had to look long and hard to be certain. I felt a wave of relief as tears rose to my eyes. I turned toward the wall and continued writing, trying to forget the intense and very real fear I had just experienced. I felt a second pang of sadness for this other young man, realizing that the feeling of dread I felt would soon be shared and intensified with his family. That morning, I drove home in silence; I was exhausted, grateful, but also fearful.

Fortunately on that day, I did not have to truly experience such loss. All who work in the emergency department have seen true defeat, sadness, and despair. All of us have also, at times, become cynical and unsympathetic. It is easy to become complicit, to make sarcastic remarks, to brush off the sadness that we have just experienced. We get jaded. While it is important that are we are able to reflect and to let off steam, it is easy to forget why we are in residency: to become the best physicians we possibly can be. We must learn medicine, but also learn sympathy.

When I reflect back on this moment, the fear feels as real as it did at that time. If it had been my husband on the side of the road and on the gurney that day, I believe that the ED team would have done their very best to care for him. But with guilt I wonder, do I always do my very best? Even in the small things that seem to be annoyances, do I take the extra moment to comfort the worried mother, to listen and actually hear what the patient has to say, to put a hand on the elderly woman's shoulder and provide comfort? Do I study with the intent of delivering the best patient care? Am I deliberately developing and practicing my skills to be the kind of physician that I would want taking care of my mother, my grandfather, my sister, or her children?

I know that I will not learn everything during these three short years. I know that I will make mistakes and have to continually adapt, learn, and develop. I believe that is why we call it practicing medicine. But I certainly hope that I never stop trying to improve, never stop working to be better, and more importantly, that I never cease to care. Sometimes we must face our greatest fears in order for us to be the greatest we can be.