What’s the hardest part of a physician’s job?

I work in the ER. It’s not an easy job. Not glamorous either. At least not as glamorous as my mother-in-law used to think.

Years ago, when I declared I was going into emergency, she looked at me askance. She didn’t ask why. She looked at me with her wise old eyes. “Let me tell you about ER,” she said. “I know all about it. I watch every show.”

She was politely dismissive and actively unimpressed. Worried about the staff having sex in the closets maybe? Or she didn’t think that my hair or my style could stand up to the job.

She was right. Not about the sex. I don’t know how the folks in the movies find the time. Or the interest. I struggle to find time to pee. And the closets? Really? You get turned on by dirty mops and bleach perfume? She was right about the hair. It’s still not worth mentioning. And my style – what style?

I eventually got used to people questioning my career choice. Patients ask me when I’m going to specialize. My best friend – a computer maven – asked me why I choose to work triage. “Can’t a nurse do that? Shouldn’t you be treating people, instead?” I tried to explain. She smiled and changed the subject. I got even by questioning her choice of husbands. Years later, we’re still friends. I still work ER, but she disposed her husband. Advantage home.

Still, every once in a while, somebody asks me a question that catches me off-guard. “What’s the hardest thing about your job?”

I stumble. I mumble. I try to say something intelligent. I fail. They try to help.

“Is it people dying?” they ask.

No, it’s not, even though I feel defeated every time someone dies on my watch. Even if there was nothing I could do. I feel inadequate and powerless. I always wonder if a smarter doctor, a faster doctor, a better doctor, could save them. I agonize about it, looking for my failing. But that’s not the hardest part of my job.

“Is it the abuse? Is it people swearing at you, throwing feces at you, keying your car and threatening to rape your daughter?”

I don’t have a daughter. These days, I don’t even own a car. I got used to the swearing and being called the c-word. I don’t like the feces or the spit, nor being bitten or kicked, but I use protection equipment. I stay out of the fray. When everything else fails, IM Succinylcholine works. I’ve never had somebody spitting at me with a plastic tube in their throat.

“Is it your accent, since these days immigration has become a dirty word?”

No. People would spend their last hard-fought breath to find out where I’m from. Romania, I used to say. That was the end of the conversation. I stopped telling them. If they insist, I say Beekmantown. My nurses love it. They can’t wait to get in on the game. If I say Transylvania, patients think I’m kidding. We laugh and get back to what matters – what they’re there for. Once only, my Dilaudid-deficient patient asked for an English-speaking doctor. I think she meant American. My English isn’t that bad.

“Is it telling families that their loved one died?”

No. It’s never easy, even if they lived to be a hundred, but it’s part of the job. I try to make it easy on them. I wash my hands of their loved one’s blood. I borrow a clean coat, even if I have to cover somebody else’s name with my badge. I lie. I pretend it didn’t hurt them, and it didn’t hurt me. I try to give them hope or solace.

“Is it being a woman? Having to deal with the glass ceiling?”

Not really, though it’s frustrating when patients call you nurse, after introducing yourself as their doctor. I didn’t suffer much from the glass ceiling. I didn’t aim high enough? A perk of age? By the time I got to be a doctor, I was past maternity leave. And handling angry surgeons is easier than dealing with macho men in Communist Romania.

“Is it the human tragedy? The drunk drivers, the sexual assaults, the children with broken bones and cigarette burns on their belly? Is this the hardest part?”

No. These are all things I can do something about. I treat, I advocate, I educate. I struggle to prevent it from happening. I try to make a difference.

“What is it, then?” they ask.

It’s making decisions. Choosing winners and losers, when I don’t know who should win and who should lose. Every shift I make decisions with limited information, limited resources, and limited time. Decisions that can mean life or death.

Some are big: Do I scan this back pain, looking for a dissection, and possibly destroy his kidneys, or do I send him home to die.

Some are small: Should I first discharge Room 9, who’s desperate to get her kids off the bus, or see the chest pain in Room 3, which may be having a heart attack?

Some I don’t know. This woman, here for the third time this week, is she a drug seeker? Or is she sick? Should I scan her again, spending thousands of dollars on her third workup? Or should I have security escort her out?

This smiling infant with a bruise on her neck. Is she an adventurous explorer, or an abused child that I’m about to send home to die? Should I call CPS, destroying the peace of this family, or should I trust her sobbing mother telling me she stumbled and fell on a toy?

And of course, they all come at the same time: the chest pain, the baby, the fire drill, the EMS call, the floor code, the radiologist calling about the brain bleed, the administrator barking at me for being behind on my charts.

I can’t do it all. Not at the same time. But maybe a smarter doctor, a faster doctor, a better doctor, she could.

The hardest part of my job is the guilt. I never, ever, do everything I should. Not well enough, not fast enough, and never perfect.

Rada Jones is an emergency physician and can be reached at her self-titled site, RadaJonesMD, and on Twitter @jonesrada. She is the author of Mercy and Overdose.

Image credit: Shutterstock.com

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