I’ve noticed that my job satisfaction goes way, way up on days when I am running around taking care of real sick patients. By “real” I don’t just mean magnitude, but also authenticity. These are legitimately ill patients who require my expertise in Emergency Care. These patients are who I was trained to care for. Crisis interventionalist – that’s what I am. I am not happy nor do I feel fulfilled when dealing with drug seekers, or with whining, manipulative and deceptive patients. I find that the elderly are “real” patients for the most part and typically do not have a secondary or hidden agenda.
For instance, there was one day during a span of 9 hours, I had (as I jokingly stated) a “5 to a flush” deck of cards i.e. 5 critical patients all going about the same time. There was the 90 year old, perfectly lucid patient who was stroking out in front of me and was given TPA. There was the 70 year old septic patient whose blood pressure would not go above 90. Then there was my 70 year old man with Addison’s who fainted and also could not keep his blood pressure above 90. And, fourth was the 60 year old alcoholic who fell, broke her ankle at home and couldn’t get up, who said – with a straight face – that she didn’t think alcohol had anything to do with her falling down. Oh, and last but not least, I was asked to see an overdose patient semi-unwillingly (I didn’t really want to pick up a patient so close to the end of my shift,) but the patient was unresponsive. It was so busy that night, and the other physicians were occupied. She turned out to be very sick, legitimately overdosed on massive doses of xanax and celexa. She had to be intubated and put on the vent.
Days like that are trying yet satisfying. I am being pulled every which way and sometimes it may even seem unsafe to have to juggle so many critically ill patients. However, the decision making is not tremendously difficult for a well-trained and experienced ER physician. It’s just that there are just so many decisions to be made while caring for the critically ill. I jokingly say – routinely – that “my brain is tired.” There are literally hundreds of decision we must make throughout our shift. This is intellectually exhausting. But, it also can be extremely gratifying and fulfilling especially if the shift runs smoothly and you get your patients out of the ER alive. There is nothing like the feeling of exhilaration knowing you have helped these very sick patients and gave them another chance.
Yup. The sicker they are, the happier I am.