By Dan Pitt – Emergency Medicine Trainee
We’ve all been there. The dead of night. Ten names still on the screen, their wait times ticking ever closer to the four-hour mark. Patients or relatives who have been waiting the longest stand, if they can, at their cubicle entrance, staring, eyebrows pulled together, attempting to make eye contact and draw you towards them. Honestly, it makes me a little anxious to type.
I have to see all these people. What if I can’t figure out what’s wrong? What if I cop a serve when I wake somebody to make a referral? What if they deteriorate?
It’s often hard to avoid the negative thoughts. And really, they should come as no surprise. The Emergency Department (ED) is, even on the calmest of days, a melting pot of emotions. The ED is, by its very nature, prone to unfavourable emotion. Whether it’s the distraught family that have just been told their loved one is dying; the patient struck down by crippling anxiety; a parent filled with worry about their (probably well) child; the renal colic patient, terrified because he has never experienced so much pain in his life. In ED, the majority of the time, the best news you can give is that you don’t have bad news. It’s sometimes easy to get overwhelmed by the negativity.
This might be an overly pessimistic view. But I think it’s the reality. We get up in the morning (or evening), we have our coffee (or two), we drive into work, to help people through one of the worst – if not the worst – days of their life. Of course there are going to be some dark clouds hanging around. So I think this makes it vitally important that we have strategies to ward off the negativity.
I’m not particularly big on this type of thing, but I do have some, albeit informal, thought patterns that I try to recall when the department has turned into a warzone.
- I recognise that I can only work at my limit. More than once I’ve found myself in fast track (or ambulatory care) fretting about the endless number of patients that lie ahead. When I stop, and recollect, and realise that worrying about the names on the screen is not going to change the rate in which they get sorted, my shift usually changes for the better.
- I remember that the sun always rises – a lesson I learnt during the dark ages of night ward call. There’s no feeling quite like seeing the sunlight creeping across the floor at the end of a busy night shift. It’ll always rise. There will always be a consultant rocking up in a few hours to take my horrible handover.
- I vent. Some people call this debriefing. The trainees that I work with would probably tell you that I whinge. Being able to vent to friends, colleagues – similar-minded people who understand the highs and lows of a day in ED – is great medicine.
Don’t get me wrong. There’s so much to enjoy in emergency. Whether it’s the satisfaction of an apnoea-free procedural sedation; that pleasant crunch of a fracture being pulled into place; the gratitude of a patient going home without nausea or pain; or the sweet silence following a dart of droperidol. It’s the summation of a myriad of positives which make it all worthwhile. Worthwhile without a doubt – but worthwhile doesn’t make it easy.
It’s a tough gig. On a good day it can be a storm and on a bad day, a cyclone. We all have different strategies for dealing with this, but I think the key is to realise that this is a part of working in ED, to recognise when the storm is overtaking you, and to then change the course of your mindset before it’s too late – or, at the very least, remember to look for the rainbows. And, of course, if nothing else works, refer to Med.