I have a lot of energy. I have been going and going and going for so long. And today, it hit me. I’m tired. I began this pursuit of medicine in 1983 when I decided to be a zoology major. I worked and went to medical school. And I went to medical school and worked. Then I worked and went to three years of emergency medicine residency and worked hard for those three ...

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A middle-aged man lies on a gurney. Anxious. Work boots. Blue jeans.  Stained white shirt. Rough hands. "Hi! I’m your doctor. What brings you to the emergency room?" The patient looks at me, puzzled. He’s Spanish speaking. It's the middle of the night, and I’d rather not use the translator line. We start in broken English – then I reach for the phone to call the language line. He collapsed at work, and ...

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A 4-day-old term, formula-fed male infant with an uncomplicated prenatal course and no ABO set up or other identified cause of excessive jaundice was admitted to the hospital for phototherapy treatment of hyperbilirubinemia with a peak bilirubin of 19.5. He had an uneventful hospital course and was discharged on day 6 of life.  On day 8 of life, his mother called concerned that he was fussy and had a black ...

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That first day of mid-March in the call center that was later to become the headquarters of our student lead COVID-19 hotline, the disorganization and confusion were almost palpable. I remember the other fourth-year student at the time, Eda, trying to manage the newly arriving group of student volunteers while simultaneously answering a phone line that was ringing off the hook. I remember the blur of motion as three nurses ...

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The little things? The little moments? They aren't little ... I noticed the two of them shortly after I arrived for my shift. I was standing at the counter, immersed in a chart, when out of the corner of my eye, I saw them walk out of their treatment room. Together. Slowly, they walked into the hallway, looking first to their left and then to their right, wondering which way to go. One of ...

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"As a physician working with human trafficking survivors, I have become accustomed to those with a history of surviving violence. But the patient in question is in my general primary care practice. This should highlight to care providers that there may be many more patients out there who have been exposed to trauma in their past, and we need to take ...

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"As I read about Dr. Breen, saddened by the fact that we have been robbed of yet another young, promising, motivated physician, I am reminded that as bad as this pandemic is — and truly believe it is awful — when it gets better (and I have to believe that it will), we can’t forget. Because all the other things that have always ...

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Walking through the sliding glass doors at 10:55 p.m. on a Monday, I found myself wondering if it would be a good shift or a bad shift. In emergency medicine, a “good shift” has to strike many delicate balances. It can’t be too busy, but it also can’t be too Q-Word-That-Must-Not-Be-Named. It should have some high acuity patients, but not so many that care becomes unmanageable. The staff and residents ...

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Despite the fact that many people have difficulty finding a family physician, there remain many options for medical care. From emergency departments to urgent care clinics to clinics based in retail stores and pharmacies, there are several different ways to see a physician, physician assistant, or nurse practitioner. This is can be useful when one has no family physician, or can’t get an appointment. It can be difficult and downright dangerous ...

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My small community ED has a fairly high acuity. As such, I was recently trying to transfer a couple of patients, one of whom was an NSTEMI, pain-free but with a rising troponin. In the process of trying to arrange things, I learned that our main regional referral center was holding a staggering 150 patients in their own ED, all waiting for inpatient beds. I've spent the majority of my career ...

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Being humane makes you a hero. It is a privilege to serve. Be the voice, for those without! Six words. One Story. These are examples from the My Six-Word Story Project, an innovative activity that supports the psycho-social well-being and emotional resilience of our healthcare professionals. My Six-Word Story has the power to reconnect us to our purpose and connect us as a community. "It's your reaction to adversity, not adversity itself that determines ...

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The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, including bypass surgery, he was only in his late 40s. His transport from his house to our department had been less than 10 minutes, and the pre-hospital team had done an excellent job of intubating this patient and establishing an IV to begin ...

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“A lot of times, people don’t know what they want until you show it to them.” - Steve Jobs I was rusty. I felt rusty, at least. It had been forever, seemingly, since I attended patients as an emergency physician. A couple of years earlier, I’d been sailing along happily in my clinical career when a cancer diagnosis blew in like a hurricane, shredding my sails and dumping me into a sea of medical and ...

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"Is it possible to have it all?  Can you have a job that you love, helping people and using your brain and hands all at the same time; plus, a family, with a spouse and children, that you are always there for?  Is it possible to have a balance between your work and your family live while working as a medical ...

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An excerpt from Ballad of a Sober Man: An ER Doctor's Journey of Recovery. As if I needed more reminders of my imperfections, I had Maggie and the Kidney Stone Lady, forever. Little Maggie, the cute five-year-old from early in my career who came in with her ...

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I love being an emergency doctor. I loved my residency, my co-residents, and my attendings. I love my training: watching, learning, treating. I love the emergency department, the vastness, and the variability of emergency medicine. But I am tired. I am tired of feeling like a workhorse, a production line made to just churn patients in and out. I am tired of being told that my worth as a doctor is based on my time ...

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I am about to express a wildly under-advertised piece of advice: Our nurses are our most valuable resource. This reality has been true for physicians for many years, but with months of lost time on in-person rotations, it will be true for us more than any other class. My career in medicine started while working as an ED tech. It was a night shift job to get me through my degree ...

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"We care for patients suffering from addictions every shift and are often the only care providers they can turn to. Despite our best efforts, we are often forced to watch as these patients continually succumb to their addiction, sacrificing their bodies as collateral damage in the battle. What frustrates me the most is that every time one of these patients leaves against ...

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There are many jobs where people work long and hard. But I will assert that none train as long and hard, and at so much expense, as doctors/surgeons that manage the emergencies for their specialties and take night call, on top of managing a full-time practice. The key point I am trying to make is that doctors, as a profession, basically agree to “show up.” That is what sets us apart ...

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I was reading this article in the New York Times about Dr. Lorna Breen, and it literally took my breath away. This awful pandemic has claimed so many lives, in so many different ways. Sadly, it made me think of a medical school classmate of mine who took his own life a few years ago. He arranged for this to post to Facebook:


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