There is always that one patient. The one with the over-attentive, aggressive family member, who writes a complaint. The one you tried to help, but no matter what, the wait was too long, the nurse too unfriendly, you didn’t sit enough, you didn’t reassure enough, pain meds took too long, you didn’t make them feel important. That one patient who has the time, negative energy, and physical health to write an email to patient relations. That one patient whom the nursing supervisor emails you about, asks you to answer to in a formal response. That one patient, who was not even that sick, whose diagnosis you don’t even remember, but you will never forget the feelings of anxiety, the deep pit in your stomach, the churning acidity of coffee and frustration, the feelings of worthlessness, defeat, exasperation. The one patient who makes you wonder why you keep doing this shift after shift.
There is always that one patient. The one that was discharged with a smile. A genuine thank you. That one patient that you went out of your way to help, reassure, diagnose, treat, and care for. The patient that just needed someone to help them talk their way through whatever they searched on WebMD and is so thankful and grateful for your knowledge and expertise. That one patient whose family members acknowledge and appreciate the extra lengths you went for a quicker dispo, a social admission, a soft discharge to go to a grandchild’s recital, with the assurance that “I will be right back after.” The patient that probably does not have the time or interest in writing a survey response, but whose smile, wave, and “thanks, doc” carries you the rest of the shift. And bolsters you through the next one.
There is always that one patient. That really sick one. That you knew was going to pass away, too young, just hopefully not in the department. Not during your shift. Not today. That one you frantically searched the deep recesses of your mind all the way back to basic sciences, and FOAMED resources, and alternatives in obscure international journals, trying to find the esoteric reference to the one trial, or theory, that may save them from an untimely, unnecessary, and wholly unfair death. The one patient who could have, should have, in an alternate universe, lived a full life, if only for good follow up, insurance, health literacy, or a bit of better luck.
There is always that one patient. Who ignites the smallest recesses of your soul and whose face you will always remember. That one patient, who reminds you of someone you love, whose diagnosis strikes a personal chord, whose story reminds you why you applied to medical school in the first place. The patient who acts like an oasis in the middle of a busy shift, adds a bounce to your step.
Emergency physicians see an average of anywhere from 20 to 40 patients per shift. We are able to leave most of their stories in the hospital. Inevitably, some of them follow us- like an albatross we can’t shake, images and experiences that replay on a loop during a run, voices that rise above the soothing flow of a shower, woven into our dreams. We need to learn how to only allow the patients who uplift us, or make us better, follow us home. Burnout is real, and learning how to leave the anxiety, frustration, and desperation in the hospital will allow us to continue to treat patient the way they- and we- deserve.
Elizabeth Rubin Ribak is an emergency medicine resident.
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