YOUNG PHYSICIANS SECTION
Two Years Later Priya Ghelani, DO FAAEM
T
hird and fourth years of medical school are often when medical students find their “calling.” Many know instantly. I wish it had been that simple for me. I chose to pursue medicine years ago because I wanted to do primary care but quickly realized I was not quite cut out for clinic. I flirted with the idea of general surgery but was swiftly enticed by the words “work-life balance,” and briefly thought I would pursue critical care before I remembered how bored I felt with management, rather than diagnostics. Ultimately, I kept finding myself gravitating towards emergency medicine with the perfect blend of versatile cognitive and procedural skills. There are plenty of pros to emergency medicine, the most obvious of which is that we get to make difficult diagnoses and save lives every day. To be perfectly honest however, there are plenty of cons to our field as well. Shift work is not easy. Nights, weekends, and holidays affect our
Despite repetition, it often feels like some things only seem to get harder, rather than easier, every passing day.” family and social lives. The lack of adequate public health infrastructure has progressively weighed down our emergency departments, with no end in sight. The inability to own our own practice makes us dependent on sometime arbitrary rules made by hospital administrators incentivized by profit margins, and excludes us from profit-sharing models our other colleagues in other specialties have the opportunity to benefit from. Making high stakes decisions regularly contributes to the escalating rate of burnout among emergency physicians as studies continue to remind us. Despite all of this, in the chaos of the ER, there are moments every day that serve as a reminder as to why I was drawn to the field as a young medical student. We are privileged to care for patients from all walks of life, from the undomiciled to the most affluent, during a time of vulnerability and need. Not having to worry about payment plans or insurance, but rather focusing on and addressing their emergent and immediate needs in a rapidly changing healthcare world which appears to be becoming more transactional in nature every day feels truly liberating.
Pulseless, torsades, apneic, VT, penetrating trauma—these are words we hear every day and have seconds to act on to actually save lives. From initiating ECMO to troubleshooting LVADs, to pushing TPA, to managing a septic neonate, our ability to manage complexity never fails to humble me. Patients are far from algorithmic, and they present far from the way our textbooks read. We frequently arrive at convoluted diagnoses, from the dizzy patient who ends up being a submassive PE, to the vomiting patient we choose to give contrast to despite their renal function who ends up being a basilar stroke. A dissection flap, an intramural thrombus around a leaky aorta, or a large right heart on ultrasound clues us into why our patient is in extremis, and from there we act as conductors in an orchestra, with no room for error, working as swiftly as we can to save their life. There is a constant flux of emotions throughout a shift, from the hypoxic bloody airway that is rapidly converted to a cricothyroidotomy, a child struck by a drunk driver who arrives in severe hemorrhagic shock, a pregnant woman who tries to drive off a highway to commit suicide. “I’m so sorry, but it appears you have cancer which has spread to your lungs and brain” is a painful thing to say to a patient in the emergency room who you met a couple hours ago and likely will never see again. So is “I’m so sorry, sir, but your father is dead.” Despite repetition, it often feels like some things only seem to get harder, rather than easier, every passing day. I’m often asked how I would describe being an emergency physician during the pandemic. It is two years later and I’m still not sure how to respond. I was in New York City when the pandemic first took hold in America and previously wrote about how that experience forever changed my perspective of the word “hero.”1 While we continue with the peaks and troughs of the virus, it remains an easy topic of discussion. What is the ER like right now? Are you seeing a lot of patients with coronavirus? How busy is it? Is it true, what they are saying in the news, about the ER being overwhelmed and full of sick patients? In early 2020 at the height of the pandemic, I pondered about it all. I thought about my own mortality, my nuclear family, and what my role would be during the pandemic. When they said we didn’t have any personal protective equipment, I wondered if we were also ill-fated, and curiously wondered what my own short-lived legacy could possibly be. When they said we have too many admit holds in the department and asked us to see patients in the waiting room, I wondered what our future as a specialty looked like. And when they said we had severe nursing shortages and we cared for patients as best as we could in the waiting room, I wondered how any of this was ever our patients’ fault (or, might I dare say, our own). My own family members passed away due to COVID-related complications this past year and I struggled to maintain optimism despite it all. >> COMMON SENSE MARCH/APRIL 2022
55
