posted on: Monday, November 5, 2012

it has been a rough week, y'all.
this is the part where my job starts to kick my heart's ass.
i'm overworked and overtired, yes.
so what else is new.
but this week has been about more than that.

an instagram repeat. harry potter the doctor. my halloween costume.

that was my halloween costume.
some people didn't get it, 
because i never got around to drawing the scar on my forehead.
just as i was about to, my first patient of the night was a guy having a heart attack
and his wife looked terrified...white as a ghost.
i figured she didn't need her husband's doctor 
to be dicking around with a lightning bolt scar on her head

but i digress.

i've had some rough cases.
usually i try really hard not to refer to patients as "cases".
but it's becoming a self-preservation mechanism.

in one week, i had a shaken baby,
a young woman who bled out into her pelvis fracture and died.
cracked a five-year-old's chest and still couldn't save her.
and spoke to a woman with severe pelvic and femur fractures for the last time before she coded and died in the OR.

this isn't a post about the medicine.
i don't care about the cerebral aspects of it all.
"you did what you could."
"can't save them all"
"this stuff happens"
so what.

i'm writing about my struggle to cope.

i think i referenced the fact that i cried at work last week.
maybe some of you cry at work all the time.
but it's not a very popular thing to do where i work.
being an emergency department in a military hospital,
it's much more acceptable to tough it out.

partially, i think, because people don't need you crying all over the place
reminding them that they're humans, doing an impossible job.
but that's neither here nor there.

i've struggled this week.
not just because i cried at work.
i'm actually pretty okay with that.
it might not have been the popular, cool, or tough thing to do
but it seemed like the human thing to do.
to cry when a four-month-old has old, healing rib fractures
and blood in his brain and retinal hemorrhages.
to be horrified that someone, anyone, could do that to a baby.
and to have held it in long enough to get the baby up to the PICU where he would be safe
before letting it out while finishing up the paperwork. 

that experience drained me. 
i was physically and emotionally exhausted when it was over
but it was only 11am.
and i still had 4 hours left in my shift.
more patients to take care of.
so i swallowed my emotions
and put my work face back on as best i could.

the next couple of rough cases barely fazed me.
but then we received a five-year-old traumatic arrest
which means that her pulses and breathing had stopped as a result of her injuries
she wasn't in a car seat when the driver of the car she was in
swerved into oncoming traffic
and hit a bus.
we did everything we could, including cracking her chest, and still couldn't save her.
that one barely fazed me too...
...at work.
but the next day, i was a wreck.

then yesterday,
a woman was hit by a truck in the church parking lot,
crushing her pelvis and her femur
but she was awake and talking to me for the entire time she was in the ER
then she went to the OR and succumbed to her injuries.

i'm starting to wonder how much more i can take.

the easy thing would be to just stuff it all down.
to chock it up to being part of the job
but i worry that it makes me less human, if i choose not to feel it.

and that is my struggle.
i'm equal parts terrified that this job is going to make me hard and cynical
and terrified that it won't.
which would be worse?
to be an emotional basket case after strings of cases like this because it's all just so horrifying?
or to be a hardened shell of a human being who takes it all in stride?


i have a hunch that there are going to be many more tears shed at work for me.
and thanks to Zooey, i'm starting to feel a little more okay with that.


  1. You are amazing to deal with all this pain. I hope you have equally as many joyful moments at work soon. I hope every ER has caring docs like you!

  2. I think being human is the right thing to do. Lots of people turn into hardened shells of who they once were and become so disconnected. I think your emotions are a testament to the physician that you are and how deeply you care about your patients and that is a good thing, Em! xo

  3. I am whole heartedly with you on this. I have worked in the ER now for 4 and a half years (as a PA) and I can tell you that I feel the exact same way. It is heartbreaking to see some go and exhilarating to save a life .....

    I can tell you that it does get better, but that also makes me hurt. Why does it get better? Do we get used to death and tragedy? I don't want to be used to THAT.

    I could go on and on with this, but keep your head up and keep saving lives. We need all the help we can get :)



  4. It would be weird not to feel it. I have bawled after some work shifts, and I still think of some patients years down the track. And I'm not even a doc! But my husband is training in onc (but is on a year break atm) and says the trick for him is to remind himself that he didn't give his patients cancer, but he can make their life (and death) as dignified and painfree as possible. Be gentle on yourself - we need docs who care :)

  5. I think you're amazing, to be able to see what you do and still manage to keep a level head enough to "do everything you could". It takes a stronger person than most to manage that personal dichotomy, so I think it's something to be proud of, this openness to being human. When you see the worst over and over again, I think you have to let it out somehow- and tears are so cathartic. If anything, those tears are leaving your body temporarily so that you can be stoic for the next patient.
    *giant hug*

  6. I think being emotional about your patients is going to make you a better doctor. You care about them and that means you won't take their lives for granted. You'll do absolutely everything you can, even if that means being the last person to talk to someone before they die. At least they will have a nice doctor who cared about them to talk to.

    I've dealt with several health professionals this last year who seriously needed to change professions. I know a certain amount of detachment is necessary for medical professionals (so you don't go cray-cray), but compassion for patients should still be a requirement.

    As for the shaken baby and the 5-year-old... it amazes me every day how completely incompetent some parents are. You need a license to drive a car but anyone can have a child and totally NOT take care of it. And after dealing with infertility, that kind of crap really pisses me off. Especially after you hear people say shit to you like "it's all a part of God's plan". Yeah I don't buy it.

    Sorry for the swearing.

    You're doing a great job. I think it is best to cry it out.

  7. this all hurts my heart so much. I was never a doc nor did i save lives, but when i worked at the childrens hospital, and would come in and see the butterflies on the room doors i would have to hold back tears (butterflies meaning a child passed). I eventually got used to seeing butterflies. But still would spend time with certain patients that would make me cry when I left. I know for me, i would want a doctor with a heart like yours.

  8. I sit and stare at my cursor flash in this comment box and I want to say something helpful, profound or even...right for the situation but I've got nothing.
    What you do every day is profound. I cannot even for the life of me try and see how it would be to be in your shoes, but I'm thankful that someone like you is out there in the medicine world. My husband is a first year resident, and I've met Doctors that have become "cold" or "distant" from their patients and cases, and I hope and pray that never happens to him. I think your emotional reaction is completely justified. Hell, if you didn't have reactions I would worry about your heart and soul.

    I know it would be easier to brush those people (cases) off your sleeve, but I truly believe they will help in shape you into a Doctor that is successful, respected and loved.

    Thanks for sharing this - I'm sure it wasn't easy to write as it wasn't easy to read. Your honest is humbling.

  9. I think Corinne said it perfectly. I have so much admiration for what you do. Sending good thoughts, prayers, hugs..all that good stuff! :)

  10. I can't imagine having a job like yours... there are no words to make it better but know how much people you don't even know and the families of those people you fought so hard to save- appreciate a doctor who cries. Who feels their pain. Who knows that life is precious and isn't just a case.

  11. That quote... perfect.
    I want to thank you for sharing this with us... with me. I meant the world and I hope that one day I may be as stellar of a doctor as you Em darling. You are seriously my hero/role model.

  12. I've never commented on this blog before (not a big commenter in general) but this post is something I emphasize with on a daily basis. I work as a clinician, and have done so in many different types of ways. I've worked with traumatized children, juveniles in jail systems, young adults in residential care for their metal illness and so on. I have had clients of mine take their own life, or die of overdoses. I am not a doctor, and realize I could not ever identify your type of pain in dealing with your clients, but I do know the constant fear of walking into work and worrying that someone could very well die today. The way I have learnt to deal with the awful stuff I see is to take an extra moment with the good stuff. Its easy to overlook that stuff, to forget how good it is, how good we are, how good our friends an family are. When I have an especially rough case I list 5 great things in my head and then allow myself to mourn what I need to. What I'm really trying to say is not to forget to balance it out, because life creates a balance, even when it all seems so imbalanced. Or at least I think so. Good luck to you in this. : )

  13. thank you so much for this post.

    I am not here to tell you that you did all you could, and that it is okay to be upset because it is human. You already know those things.

    But I am here to tell you how much admiration I have for people like you. I consider you a hero, even. What you do is amazing, incredible. You are making such a difference. I don't think I would ever have the strength to do what you do.

  14. You're pretty awesome for doing the work that you do every day. Reading about the patients you have and what happens to them, is really sad and scary. So a huge thank you to you for doing that amazing work. I can't imagine how it feels to be in that position, but I understand how it must be hard to be strong and not show your feelings in moments like that.
    I guess alll I can say is I'm sure you're doing the best job you can, and you shouldn't beat yourself up for crying at work, or things like that. I actually think tears aren't a bad thing, because it shows that you are a human, and I'd rather have a doctor that's human, than one who's not.

  15. Wow - I have read this like 3 times today and I still this what Corrine said is spot on and I believe that Zooey's quote is Ahhh-Mazing... I thank you for your vulnerable post, and yes - I guess it gets easier - but to be honest - things will never stop bothering you in some way and I think supressing them is worse that crying in a storage closet or screaming in the shower after a traumatic event such as those. I don't mean to sound like I'm an episode of Grey's Anatomy - but the providers I know that are cold and cynical and are not better off for that attitude. Yes you are a doctor, but you are human and humans have FEELINGS... Give in to the pain abd then let the people whose life you save be what your mind travels to rather than the bad outcomes... There were many great replies and this was a great post... God Bless You... Hang tough!

  16. The tears just won't stop and nothing I say is going to be right or enough... But well done Em, you are an amazing woman and your heart is so big and so warm. Your job is heart wrenching but the Lord has chosen you to do what you do because you can and you do it so well. I have the utmost respect for you.

  17. never let go of the emotions. you are strong enough to feel and continue and if you ever get to a point where you're not, you can walk away. god gave us both good and bad emotions for a reason. you will appreciate the baby's life you saved that much more. feel whatever you feel. be sad if you want/need. you are AMAZING. for reals. i don't actually know you, but I admire you so much. thank you for your service.

  18. i think you will always have a mix of both- my mom still gets emotional with some cases, and others she can just let go of.

    it's never easy when it's kids.

    a big hug to you. and anytime you need a hug, you can just take one from me, k?

  19. Oh my, thanks for this. I don't face nearly the extreme emotional situations you do at work, but I do work in an incredibly cynical industry (entertainment), in a stereotypically cynical city (LA), and in a profession dominated by men-in-suits (law). I struggle everyday with the way my work wears on my softer/feminine/creative side, and I've been trying my best not to grow that "thick skin" as women we're told we need to survive in tough careers. I have no answers, but I can relate. And I love Zooey.

  20. If I were there, I would most definitely cry with you. I cannot imagine even for a second what that is like to go through so much heart break on a regular basis and have to watch the families take it all. I think you're an amazing doctor for having such a tender heart.

  21. I believe that it's healthy to let out those emotions instead of trying to act like they don't exist. You ARE human and you do feel those emotions, and there's nothing wrong with that. I don't know much about your work and how often you can take a few minutes to breathe, but maybe take a few more of those?

    Praying for you. I can't even imagine. But you are a strong woman.

  22. I relate to this all too much. I even had to take a step back from working in the ICU for a while because I felt surrounded by death and it was making me a bitter bitch. No family member wants a nurse or doctor who is bitter and uncaring. So cry, sister! Cry for all those untimely tragic deaths even if its not the 'cool' thing to do. And that's always easier said than done. I prefer to cry on my own instead of around anyone.


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