Writing and an emergency medicine life

April 3, 2016

I’m an emergency physician and a writer of fiction, and there is an inherent paradox in these two activities. When writing, I work with words on a page to create lives that readers will hopefully care deeply about. Meanwhile, when I’m working in the emergency department, there are moments when I’m faced with real people experiencing real suffering and I wonder why I don’t care more.

The great writer Tobias Wolff once said, “When I sit down to write, I discover things that I have, for one reason or another, not admitted, not seen, not reflected on sufficiently.”

And that’s the essence and beauty of writing, whether it’s writing fiction, an essay, or random notebook scribbling. By laying down words into sentences and sentences into paragraphs, I find myself thinking differently, making previously unseen connections, and discovering untended fears and blemishes. Read the rest of this entry »


Fatigue, not just for the weary

February 29, 2016

Nothing makes me feel old like a night shift.

Even though I say that all the time to my residents, I think that ‘old’ probably isn’t the right word. I think that what I really mean to say is fatigued.

Fatigue (n.) fa·tigue \fə-ˈtēg\: 1) labor; 2) weariness or exhaustion from labor, exertion or stress; 3) tendency of a material to break under repeated stress

The tendency of a material to break under repeated stress. Nine A.M. after a long 12 hour overnight shift in the Emergency Department, I sit in front of my computer and stop to wonder if it’s possible for me to break under repeated stress. We hear stories of this or that ER doc who cracked under pressure and quit the field or the other ER doc who had a nervous breakdown in the ambulance bay. Eventually you start to wonder exactly how much repeated stress that might take.

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A Journey to Kale and Quinoa

December 7, 2015

Michael, a man in his late fifties, presented to my emergency department with left-sided arm and leg weakness suggesting a stroke. The symptoms began the night before, but he was still able to walk. He got himself to bed, neglecting to mention anything to his wife Dana. The next morning, he woke with a headache and his weakness had worsened. He was no longer able to escape his wife’s attention. On presentation, his blood pressure was markedly elevated at 207/112. His exam demonstrated mild left arm and leg weakness and subtle sensory changes. His workup was normal except a head and neck CT angiogram with scattered atherosclerotic disease, with no stenosis or brain ischemia. An aspirin was given and his blood pressure managed.

Michael had only visited with a physician twice in twelve years. His misconception of health as the absence of a named disease led him to avoid doctors. He, like so many of our patients, had central obesity, the result of a typical American diet and lack of exercise. He admitted to stress related to work. I learned weeks later that the source of much of his stress ran layers deep.

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Survival of the Fittest

November 19, 2015

An observation that I and many of my emergency medicine colleagues have made about vacations: we need them. We need them for wellness, to recharge, to recover. Great saves, terrible tragedies, we witness it all and it can wear on you. Unfortunately, when vacation plans are made, it is not uncommon to find oneself working even more shifts before the break to offset our absence on the schedule, making the time away absolutely critical by the time it rolls around.

And so after ten shifts in thirteen days, I find myself exhausted, unprepared, nervous, on a hot, humid bus that is supposed to be taking us to the dock but instead slows unexpectedly. A land iguana, a golden brown ancient dinosaur, creeps off of the road into the side brush. Piling off the bus, we are directed toward a concrete platform adorned with huge lounging marine iguanas. I gather my belongings and catch myself from stumbling, nearly stepping on an iguana’s whiplike tail that seems to have appeared right next to me. It spits salt water at me in retaliation but does not move. Sally lightfoots scuttle along the jagged shore, red as the lava the rocks once were. When I ask which boat is ours, I am interrupted by shouts of “Blue footed boobie!” causing me to forget the question I just asked. This is the first hour in the Galapagos.

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Physician (un)Wellness and the Passion Paradox

July 23, 2015

When it comes to physician wellness, I’m type A noncompliant. That realization struck me midway through my last vacation, which was notable because I didn’t travel anywhere, and the most extraordinary activity involved sleeping through the night.

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Confessions of a would-be nocturnist

February 19, 2015

“Hope it’s not too busy.”

I smile and kiss my well-meaning husband goodbye, the man who has just cursed my night.

In fact, I was swamped all night. It was the equivalent of the “Q word.” First rule of the emergency department: never talk about how “quiet” it is. We all know too well Newton’s law of the ED: for every moment of calm, there is an equal and opposite hellfire of activity. Straight out of Field of Dreams, if you acknowledge it, they will come.

I have been working nights for one year now, full time. To be fair, it was at my own suggestion, borne from a need to stabilize my schedule with a nursing baby at home and two more kids in school. If I work nights, I reasoned, I can set my schedule, make dinner, go to school functions, have regular date nights with my husband, and see my children every single day! In short, I can do it all! Never mind one small but critical detail — I have to stay up all night to do so.

I have a confession: working nights has made me a little crazy.

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Reflections on Wellness

November 3, 2014
Photo by Jason Hack

Photo by Jason Hack

“You should own that,” says a colleague, and I agree.  We just attended a conference on physician wellness, my area of academic and personal interest, and we are feeling inspired.  And yet how do you own wellness? The paradox about wellness is that it’s about owning your own vulnerability, that which makes you humble and sometimes ashamed.  And how many humble ashamed people do you see racing to the top giving advice to others?

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