Forty Years

“The highest reward for a man’s toil is not what he gets for it but what he becomes by it.”

– John Ruskin

On July 1, 2018, when I drive to work at the emergency department, I will have traveled there for forty years. How is that possible? Where has the time gone? It boggles my mind to think of the events of my life that have passed since then.  Even though I’ve lived in several different locations during that period, my trip to the hospital has remained much the same.  Repeatedly, I passed though the intersection where one morning after a night shift, I was broadsided by an intoxicated airman who ran a stop sign.  Other than being knocked silly and having a mild neck injury, I ended up being as fit as a fiddle.  Oddly enough, adjacent to the site of my accident sits a large, sprawling cemetery, and I’m certainly glad the accident didn’t find me needing a place there.  Closer to the hospital, I drove past the location of a bustling weekend flea market, a now-closed tire shop and a series of convenience stores.  Oftentimes, as I mentally prepared for the intensity of my day, I motored past these nondescript spots without paying the least bit of attention to them, steeling myself for the inevitable traumas that I would soon face in the emergency department.  Someday these places will be distant memories, flashes from the past that have no meaning whatsoever.

But now, as I anticipate my upcoming, four decade anniversary in emergency medicine, my thoughts roll back to 1978, when I first began my career.  I was green, very green, and while I thought I knew a lot about medicine, little did I know at that time how much I still had to learn. Fortunately, not only did I have the support and shared wisdom of my physician colleagues, even more critical was the team of experienced nurses who had my back.  While my fellow doctors were helpful in my developing practice, day-to-day I worked much more closely with the nursing staff and ambulance service personnel. As I think back, my memories of them are as distinct as if they were yesterday.  For those of you unfamiliar with those in my past work environment, please forgive my diversion into the olden days and their associated recollections, vivid memories begging to be shared.

First, I must mention Ann, the nurse manager of the emergency department, whose innate, calm disposition kept the chaos in some modicum of order.  I never saw Ann lose her cool, no matter how dicey the situation, though I suspect on occasion she blew a gasket just like the rest of us. How could I forget Frankie, practiced and direct?  I never had to wonder what was on her mind about patients, because she always told me, whether I liked it or not.  Then, there was Carol, the night shift RN, who was more than just a learned nurse, she was a great friend, and I always appreciated her insights when difficult patients walked through the door.  Pam was Carol’s trusty sidekick during the wee hours, a solid, centered caregiver who held it together when things were going bad. Rick was a terrific nurse, great in times of catastrophe, yet he was also the ultimate cynic.  Countless times, when I asked him how he was doing, he raised his eyebrows and sarcastically responded, “Another day in paradise.”  Even now, I grin as I recall the disgusted look on his face. Barbara was one of our most emotionally collected nurses, and even though everything was going to hell in a handbasket, she remained as cool as a cucumber; she was a tough, hardened emergency nurse.  Over the years, she has moved on to more of an administrative role, and she has become one of my close friends and confidantes. Darrell was an EMT (emergency medical technician) who later became an RN.  As good as a nurse as he was, he was an even better volleyball player, and he was one of the stalwarts of the emergency volleyball team.  Besides those previously mentioned, I have fond memories of many others from 1978, including Donna, Norma, Peggy, Cobehy, Dan, Debbie, Maria, Glenda and Carol C.

At that distant time, the corps of paramedics and EMTs on the ambulance service were the finest that could be found anywhere.  The Grand Master of the paramedics was the knowledgeable and oh so wise Harvey.  He was like a walking encyclopedia, one who knew the fine details of Advanced Cardiac Life Support (ACLS) better than most physicians.  When the occasions came for our biennial re-certifications in ACLS, I shuddered when I discovered that Harvey was the one testing me. Under the pressure of his beady-eyed, intense stare, I would break out into a cold sweat, and I prayed to God that I knew the right answers to his incisive questions. Fortunately, after Harvey heard a few correct responses, he usually took it easy on me, for which I was most grateful.  Keith was another one of our superb paramedics, who, after his stint in the ambulance service, later redirected his skills to become the executive vice president of a physician billing service.  I have the highest respect for him and his accomplishments.  Judi was the lone female paramedic at our hospital in those male-dominated years, and she was Ms. Reliable, someone I could always count on to make the right decision in the field.  I want to also give shout-outs to the long-time director, Romeo, also brothers Tony and Jerry, as well as Joe, Sammy and Jeff.  Of course, I could never forget Randy and Andy, players of hot fiddles in a local country and western band. Charlie Daniels was a rank amateur compared to them.

I have chosen in this blog post to honor the memory of two very special nurses. Gail was an RN who I had worked with for a number of years.  She was atypical for an emergency nurse, in that she was generally quiet and soft spoken.  Hidden underneath her gentle manner was a caring and compassionate nurse, one who provided excellent care to those fortunate enough to have her as a provider.  One tragic day, when Gail was forty-nine years old, she contracted flesh-eating bacteria. Despite our heroic efforts, which included surgery and high dose IV antibiotics, she died on July 28, 2003.  In the aftermath, I felt like the wind had been sucked out of my sails, as from the beginning of my emergency career, Gail had always been there, and all of a sudden she wasn’t – an agonizing vacuum had been created. Another who deserves mention is Diana, who I had worked with for some time before she was diagnosed with breast cancer.  Diana was one of the most kind and loving persons I have ever met, and whenever she entered, her beautiful smile lit up the room. Her warmhearted attitude never changed, in spite of the ravages of her disease and the side effects of its treatment. While her body gradually failed, her spirit continued to be effervescent, glowing and kind.  She died on October 28, 1996, at thirty-nine years of age.  I’ll never forget her.

In my upcoming book, The Pit: Memoir of an Emergency Physician, I will go into great detail about my thoughts on the field of emergency medicine, its inherent issues, and my feelings as my career gradually comes to a close.  But the primary purpose of this post is not to share my revelations, but rather, to take a walk down memory lane and express my deepest appreciation to  those health care professionals with whom I have worked, not only in the beginning, but also those throughout my career. These include doctors, nurses, paramedics, EMTs, physician associates, respiratory therapists, and x-ray and ultrasound technicians.  Over the years, as part of our job, we have all witnessed and shared in an enormous amount of suffering, mostly in our patients, but also in ourselves as we struggled with the trauma of what we have seen and experienced. From the bottom of my heart: Thank you, everyone!  The personal sacrifices you have made to help others are far greater than the general public could ever know.

So, in response to the quote at the beginning of this blog, how has emergency medicine affected me?  What have I become?  While it’s often hard to examine oneself dispassionately, when I look deeply at my start in emergency medicine, and compare that person to what I am now, I smile. Not only have my clinical skills improved, I am much more mellow and easygoing, and certainly more accepting.  That said, I still have a bit of an edge, something every good emergency physician wears like a badge of honor.  Since I began my practice, I couldn’t be more grateful, not only for what my career has done for me, but also for those who have allowed me to serve as their physician.

Would I do it all again?

Undoubtedly.