Am I the only emergency physician who sometimes wonders who left me in charge of an ED? I should be confident in managing whatever comes through those ED doors after more than ten years of single-coverage night shifts, but each night I hear a little voice in my amygdala questioning whether tonight will be the night I won't be able to handle something. Sometimes I feel afraid of the unknown ...

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"I'm going to write a column about dating you and call it ‘Sleeping with the Enemy,’" I announced from my rocking chair. His rocking stopped. “The enemy?” The rain was falling on the trees in front of my porch and on his parade. “Why am I the enemy?” “You know, clinicians vs. hospital administrators.” “Really?” he naively asked. “Why don't clinicians like us?” I was surprised he was so in the dark. Before that ...

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"Mom, that's a little unreasonable,” piped up my 9-year-old from the backseat as we drove by an ER billboard that prominently displayed an average wait time of four minutes. “That would be stressful, seeing everyone that fast.” Even my kids understand how absurd some of today's time metrics are. “Hospitals probably make more money showing shorter wait times on a billboard because people want to go there because it's faster,” ...

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Basing medical care on patient satisfaction is as smart as basing elementary education on child satisfaction. The patient who wants a cheeseburger while going to the OR shouldn't influence hospital reimbursement any more than the child who wants recess all day should influence school reimbursement. By tying health care funds to the opinions of patients, we are letting the kids run the school. Doctor-patient relationships are based on the trust that ...

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How in the heck would three nurses and I ever orchestrate ECMO in the middle of the night in my community ED? I pondered this over tuna tartare while listening to ivory tower docs discuss cutting-edge modalities like they were part of treatment algorithms everywhere. The conversation turned to REBOA, and I wondered how many academicians had ever manned a single-coverage ED. Ivory tower medicine and my world, where ...

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I heard his little footsteps at 4:30 a.m. “Mama, the stockings are full. Can we open presents?” I had finally collapsed into bed at 4 a.m. after staying up wrapping, cooking, and stuffing the stockings to make Christmas morning as Norman Rockwell as I possibly could. I told him to hold his horses until 7 a.m. and rolled over for a few hours of exhausted slumber. I was thankful I wasn't ...

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I hugged them longer than any 10- or 11-year-old wants to be hugged by their mom, and tried not to cry tears of gratitude that they were in my arms. The last kid their age I saw was the one I had resuscitated and admitted to the PICU just hours before, and it took my breath away to think about that happening to my sons. I had to make one ...

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He didn't correct me when I addressed him as “Mr.,” only grimaced in his hospital gown like any other 80-year-old with abdominal pain. I knew he was intelligent when he began giving a history of present illness so precise I could transcribe it verbatim into my note, but it wasn't until he described his pain as “epigastric” that I gleaned he had a medical background. “Are you medical?” “Yes, I'm a retired ...

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"Good morning, Sandy. How was work?” How do I answer that in a normal way? Any given shift in any given ED is comprised of the gamut of emotions playing out behind the calm facade of physicians and nurses. Afterward, we often don't articulate or even process the roller coaster of feelings. The story of a recent Monday overnight illustrates the wild ride of emotions most people don't realize that emergency ...

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