Why I Enjoy Working in the Emergency Department

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The Emergency Department (ED) is a fast paced, high stress environment. People either love it, or hate it. It's no secret that the ED is NOT all butterflies and rainbows. It's filled with chaos, endless alarms/beeping, and usually filled at maximum capacity with patients resulting in an at least 3-hour wait in the waiting room. Of all the specialties that you can work in that is going to guaruntee no lunch break, minimal bathroom breaks, a million interruptions, an endless list of tasks to do, and getting yelled at by at least 3 people per shift (whether its patients or specialists your consulting) it is indeed this one.

Not only can the environment be taunting, but the patients to be seen can be, too. You never know what you're going to see, or who is going to walk through those ED sliding doors. Most people who come to the ED to be seen are not true emergencies. They're patients who could've waited to be seen by there PCP in a few days, or honestly, could have managed their symptoms and waited this 24-hour GI bug out at home. However, mixed in with the majority non-emergencies are truly sick patients. These are the patients we need to make sure don't slip through the cracks. A lot of the time these sick patients look sick. However, sometimes it's not always so apparent from that initial examination, and it is important for us to make sure these patients are priority. It is truly the only department in medicine where you can walk out of the room of a cardiac arrest, and into the room of a patient waiting 5 hours for a head cold, being passive aggressive toward you because they waited so long to be seen.

As ED staff, we're expected not to miss a beat. We just gave our last patient with abdominal pain a likely diagnosis of metastatic cancer. It's absolutely heartbreaking, but as soon as we step out of that room, we keep the smile on our faces, sign up for the next patient, and keep doing the best that we can. It's one of the only places where staff can be assaulted by our patients, and the police/healthcare system will not do anything about it. Our job is known to be hard, so, we're expected to deal with the hardships that come with it.

Universally, the ED is always talked down upon by all other aspects of healthcare/specialists. You think we're calling for an unnecessary consult? But yet, if we didn't call for recommendations on YOUR critical patient, there is backlash for not calling. Damned if we do, but more damned if we don't. I promise we only call if your recommendation could possibly change the patient's disposition or management. In the end, we have to do what's best for our patients.

Need a space or moment to decompress? Well, we're the only specialty in the hospital without a call room. No breaks. We are always in the department. We ignore the demands of our body to try to see the next patient. Consult the next specialist. Transfer the next patient. We have no maximum capacity of patient's we can see per shift. There is no turning away patients who keep flooding into the doors because we've already seen 25 patients in our shift, and still have 4 hours to go.

I know what you're thinking. Working in the ED sounds awful. Isn't this to be about what you like about the ED? How can you enjoy working in that environment?

I will start out by saying working anywhere in healthcare is hard, demanding and stressful. The emergency department is high stress almost all the time. It is a job where you are constantly doing something, on the go, and checking one thing off of your list of tasks for 3 more things to appear. However, no one in medicine understands teamwork like the ED does. You will never see a more efficient code in your life. The nurses frankly know their shit, and get things done. You will never see a more supportive team trying to help each other out. Because in reality, we understand that we truly are "all in it together".

In addition to working with a great team, the ED is the front line to practicing evidence based medicine. I am always reading literature and reading UpToDate to make sure I am giving the most effective treatment for my patient. This comes second nature to us because we are the front line of seeing things that many have never seen before. We are resourceful. We know how to stablize patients efficiently, find an answer to something no one else knows, and always know the appropriate specialist to consult and when.

Working in the ED means always seeing something new. Learning something from your patients each and every day. Seeing something in medicine that even the specialist hasn't treated before. And we do it with grit, integrity, and a smile on our face.

Working in the ED is satisfying. Yes patients come in sick, but there is no better feeling than taking a sick patient and fixing them. A patient with SVT and low BPs? Push that adenosine or do that cardioversion, and they're converted back to NSR. Problem is fixed, and therefore, patient is now stable and well. Even fixing things like abscesses, laceration repairs, draining subungual hematomas or even paronychias. There is also nothing more satisfying than seeing a patient, doing a good H&P, and diagnosing the appendicitis, bowel obstruction, or PE that was highest on your differential. The satisfying verification that you clinical gestalt is spot on.

There is something so fascinating about seeing modern medicine work in front of your eyes. Applying the pathophysiology of a disease to your clinical practice, giving the appropriate treatment and truly understanding why it works. You are able to practice a little bit of medicine from each specialty. You know how to treat infants, children, elderly, pregnant patients, and every other category of patient inbetween. We are pros at laceration repairs, I&Ds, reductions, and pelvic exams. We see the best and worst case scenarios. We are always ready for the next crazy thing or unstable case to walk or roll (via EMS stretcher) through the door.

Working in the ED I treat common colds, diagnose ear infections, and ACE wrap ankle sprains. I reduce nurse-maid elbow, know all the vagal maneuvers to try to get you out of your SVT without medication, and know the tricks of reducing a difficult hernia before needing to call general surgery. I order blood products, pressors, and Epi. I am the first provider you see when you think you're having a miscarriage. I know how to work up your 1 week old infant with a fever. I know a little bit about everything, but yet, still know it is impossible to know everything.

I will be the first to say that working in EM comes with a lot of stress, attitude, and judgement. However, it is fun as hell to practice real medicine. To be able to see a sick patient, give stabilizing treatment or intervention, and right before your eyes, see them get better. I work with people who I genuinely enjoy being around. I have a team that I know is prepared, and is willing to lend a helping hand whenever it is needed. We break our backs day in and day out to give the best quality of care to our patients. You will never meet a more prepared, genuine, harder working group of people to care for you.

I show up to work every day humbled by the cases I see and the job that I do. I am taught something new every day, and because of this, become a better provider daily. Just when you think you have seen it all, the emergency department will, again, humble you. This job is high risk, but is compensated by high reward. It definitely takes a special type of person to work in EM. I am proud to be one of those people. I am proud to be an Emergency Medicine provider. I am glad to have the privilege to care for these patients, and practice this medicine.

For my fellow healthcare workers, no matter your role or the specialty you work in, thank you for all you do ❤️

WE ARE IN THIS TOGETHER!!

XO,

Manny ❤️

P.S. If you are a healthcare worker or student in medicine, and are intrested in talking about working or rotation in EM, please reach out! 🙂

P.S.S. If you are a fellow EM healthcare worker, what is your favorite hing about working in our field? Please share in the comments below!! ⬇️⬇️⬇️⬇️