Reflections from a Year Anniversary as an Emergency Medicine Attending

Looking back over my first year of practice in emergency medicine, it’s hard to pick out one thing that stands out. It has really been a blur. Without reflection I might not be able to appreciate the tremendous change I’ve undergone as an attending emergency physician. Change is difficult. It’s stressful and chaotic. Even change for the better rips you from comfortable surroundings and forces you to adapt.

My greatest change this past year is gaining the confidence to work in the ER without a net. During medical school, I could always grab my resident for help. During residency, I could always defer to my attending. In dicey situations you were always surrounded by an army of experienced nurses, specialists, and technologies to back you up. And even though these days I still work with great support staff and usually have my colleagues around to bounce things off of. The buck finally stops with me.

After all, that’s what I wanted. I became a doctor because I wanted to take care of people and be the person who made the ultimate decisions in a patient’s care. Well, I guess my wish came true. But when it’s you “advocating” for the otolaryngologist to come in at 3 am for the post-tonsillectomy bleed, I think back to days when I could say, “Let me put you on with my attending.” Or when I meet a healthy 39 year old lady one hour into what for all the world looks like a stroke, I turn around hoping to see a magical neurologist to confirm my decision to give tPA.

Practicing this year, I’ve experienced fear. I don’t think I ever did in residency. Sure there were stressful events like putting in your first chest tube on a sick trauma patient in front of the whole ER. But if it didn’t go well, there were two chief surgeons and a thoracic surgeon in the room. This year though, when I cared for a previously healthy 4 month old in respiratory failure, I was finally hit with the thought that “this kid may die and it’s on you.” That was sobering.

Our job is humbling. Just when you’re cruising through a shift thinking and feeling fine, you pick up the next patient and you’re brought to your knees. I think the first month of practicing I called up at least a patient from each shift just to see if they were okay. I would toss and turn at night going through the patients I saw and wondering if I did the right thing. That was me changing: coming to grips with my new reality of being on my own…without a net. I don’t call up as many patients one year later, but I still do from time to time.

This year I have faced my fears, sometimes I succeeded and others times I failed. I am by no means fearless, and hope I never will be. Working in the ER requires us to accept the inherent fear of caring for sick patients, controlling that fear and moving past it so we can do the best we can for them. This year I’ve worked to move past it and on to, I’m sure, another one of life’s great challenges.