Dedication
To Dr James Tilleard – maker of many enduring moments for many people – thank you’.
One of my favourite things about emergency is that is contains untold potential to make a significant difference to outcomes, in a short period of time.
This is based on expert knowledge, clinical skills, and the ability to quickly build rapport with a person and/or their family. There is great finesse in being efficient and understanding the top diagnostic likelihoods while being attuned to details that signal high risk, rare presentations – where a timely catch is critical in the morbidity and mortality stakes. High level skills, teamwork, a well-oiled machine – rewarding stuff.
Not every moment is at that level though; and the very same high stakes nature of emergency also make it an unforgiving master. This is not ‘normal’ work for most of society. It can come with facing high pressure and confronting great loss. Additionally, though we can love the clinical care, the external factors often cause the most stress e.g., core values mismatch, unfairness, broken community, excessive workload, perceived lack of control.
With these factors it can become an unbalanced reward (‘not worth it’). Arguably, these are the most common causes of burnout. There is much information and help available – grab it if you need it, you are not alone. It is an achievement to be proactive with your physical and mental health on a short- and long-term basis.
In my now quarter of a century career in emergency I have seen a lot of greatness and some not-so-great moments; but truly by far, my experience of the emergency team – doctors, nurses, allied health, administrative and operational staff has been one of outstanding, dedicated, passionate and highly skilled carers for whom I have great appreciation and respect. We consistently grow as practitioners. We achieve personally and as teams.
There is a good question being asked broadly in healthcare right now – ‘What is it that keeps us going?’ For me this is answered often on a small scale and yet larger stage and with more depth than we may realise. It goes beyond emergency to all clinical care and stretches even to humanity.
For some time, I thought it was simply the moments – focussing on the moments that transcend the others. You know, ‘stop and smell the roses’ (which truly does help), but there is more. A great fracture relocation with a perfect depth of procedural sedation is great patient care and is rewarding.
What about a great relocation with a perfect depth of sedation and… during re-emergence there is a connection over a spontaneous song in Resus? ‘La la la la Lola…’ the mother and clinical team join in singing. A little while later you spy the often-reserved senior medical officer shredding on the air guitar, as a young man who loves music solos away. Everyone walks away with a smile knowing these are moments beyond great care.
Why is this so impacting? It is these moments where we see and meet the needs of the person, not just the disease or injury. It is these moments that live on in our memories, in our storytelling and, even more importantly, in the lives of people and families in our care.
These are the moments that echo.
Some stories are clinical or collegial; some are sad; some are hidden (one to one, never to be known by others) and yet they stay with us. There are moments that are so brief, like an understanding glance, a kind word. Other moments are long like the multiple hours of making it through the impossible day (yet, you did!).
What is it that makes these interactions worth creating, worth savouring as purpose? I propose that it is the echo. The echo in a person’s life because of that moment and who you were to them and with them. The child sees you and shouts out ‘that’s my nurse Mummy’. Does the depth of you realise that what you brought to that little one’s journey was more than a clinical outcome – it was a trust in healthcare; maybe even aspirations that might last a lifetime?
Was it that the traumatic relocation became a fun memory rather than a fearful one? Was it that the most heartbreaking news was still clear but softened because you delivered it? Was it the ‘penny drop’ moment that you saw in a colleague or student when you shared rather then held onto your knowledge? (Did you just help to make your profession better?) Did you act with integrity (seen or unseen)? Was it when someone felt safe enough to lean on you on their hardest day – when they were at their mentally or physically weakest, in pain, unconscious, dying? Did you ever notice the trust people have when we handle their personal details, give clear liquid through an IV, explain the findings or possibilities pathway ahead with them? Are you living, leading, being one of the noble profession?
The question is – for better or worse – do you think the impact of an action stops in that moment?
This is a big question not only for emergency staff but for clinicians, indeed all humans… the moments – what do they echo in other’s worlds? What do they echo to our patients, in our disciplines. What do they echo to our colleagues and the next generations of clinicians?
Small scale, big stage, great depth. They will outlast you. This is the opportunity we have as emergency people – to make many echoes in many lives at a point of great need. Sometimes this will affect generations that follow. This is much more than a job. This is meaningful, and meaningful when it matters most.
For me and, I propose, for many of us, this is what draws us to emergency and the moments of transcendent echo. They can keep us going through the tougher times and enlarge our capacity in the easier times. I encourage you colleagues, look for them, create them, remember them. And lastly – to keep this echo alive, we must also be custodians of the givers – ie. Look after ourselves and each other – body, soul and spirit. We cannot give what we do not have.
References
Kindness Matters guide. (2021, April 6). Mental Health Foundation. https://www.mentalhealth.org.uk/campaigns/kindness/kindness-matters-guide
Leiter, Michael & Maslach, Christina. (1999). Six areas of worklife: A model of the organizational context of burnout. Journal of health and human services administration. 21. 472-89.
Post S. It’s Good To Be Good: 2014 Biennial Scientific Report on Health, Happiness, Longevity, and Helping Others. Int J Pers Cent Med. 2014;2:1–53.
WRaP EM 