Fifty Nine

"Don't do it."

A few years back a friend outside of my circle of EMS and ER circles approached me after he graduated college with a bachelors of some sort of science from a major private university then med school. He had worked as a ER clerk to pay the bills that scholarships did not cover.

ER clerks in the old days really had a tough job and were often the center of the universe in the ER. When we had paper charts they'd collate them track them make calls to any number of people and get calls from the same. Biggest part of the job was answering the near constant ringing phone. Very important because ER docs call other docs to consult with and vise versa. Depending on the hospital they ordered tests and arranged transport to other parts of the hospital or at least helped in it. Aside from looking at the old white boards the ER clerk is the person who you told everything to because they were the one constant in the ER. Since we have computer boards and pt charts are computerized as well the role of the ER clerk has greatly diminished. It's an easy way to work in an ER without getting involved with patient care. An ER clerks job is to stay behind a desk period. I give the old ER clerks mad respect.

I digress

So I got this friend who wants to be a doc they have gone through med school and is looking to specialize. He his wife and I talk about this over dinner one night and I'm asked since I am an EMS type and work in an ER what I think of emergency medicine as a specialty for him. This friends is a really loaded question. If you already asking this question you've already decided and human nature being what it is you are looking for confirmation that it is a good decision. I'm known for being blunt to the point of painful even more so when it comes to the job.

I've known some great ER docs and some real shit bag ER docs. Some are truly great human beings and sometimes the smartest people in the room hands down. Others just need to be strangled where they stand because of their sheer incompetence and lack of any social skills what so ever (I'm talking to you Dr. Klaus).

I said that and also told him this exactly:

"Don't do it."

I was asked why and I followed up with many things. Emergency medicine is constantly changing and it seems to me that the higher your education the less time you spend at the bedside with the patient. A lot of what we all do not is sitting behind a computer and checking boxes. Liability and responsibility is tremendous for the ER doc. They are the generals in the ER what they say goes and they have to be leaders. It can be rewarding but also more often than not is total drudgery. Which goes for most any job anywhere. There is a shit ton that goes on behind closed doors that the ER docs do that I don't know about. There is a ton of politics played in the private groups in hospitals. When I worked at a private hospital with a small ER group I saw it fairly close up. You can be a fantastic doc and still get shit out the other end because you were on the wrong side of an argument with administration. I saw it happen a few times and it was always sad. ER docs have a lot of power but not as much as you think. ER docs are in essence the middle man, the jack of all trades and master of a few. They treat a patient and if the patient is seeing another doc they gotta call them and see what their doc wants to do. Waiting on that call back can be an aggravating experience for everyone concerned in the ER. I've seen docs do nerve blocks for a patient with a tooth ache and turn right around and read a vastly complicated EKG and decide on definitive care for another totally separate patient.

Let me dig myself in deeper because I'm too stupid to shut the fuck up. To me it seems like the financial crush of loans and the way over the top commitment to become a doc before you specialize is an astonishing achievement, truly a pinnacle. With that said why waste that on working in a ER. I told him do any other specialty get stupid rich and do cardiology, neurology or open your own colonoscopy clinic. That way you are not at the mercy of a hospital administrator or senior members of a large ER group. Do something with your doctorate in medicine where you can have nights and weekends off and be able to send your kids to a great liberal arts private school and college. Not do something where your life is put in danger every shift or where you get nightmares from what you've experienced as a doc in the ER. Don't do the job because you'll get pushed around by every other specialty and get shit on from down below and from a great height.

I told him doing any kind of patient care in a ER will change you and in my experience not in a good way. Its a whole different universe from ER clerk to ER doc. He's a great guy and honestly I did not want to see him change or be hurt from the crush of what I know about working in a ER especially going through residency in the hospital I work at, oh man oh man it can be awful. In short I wanted to protect my friend.

I had one ER doc tell em that his dad who was an ER doc as well told him not to be an ER doc. In fact his dad was pleased as punch because his son was an artist. Well the son felt the pull of ER medicine and went through the whole pipeline to be a ER doc. When he got his residency his father told him that he was proud his son got his doctorate but that he was a total idiot for being an ER doc now.

I guess I did not get my point across well or explain it clearly enough. He applied for residency and got it at a major hospital in another state. We stayed in touch as much as possible due to the constraints of being a resident. Towards the end of his residency we crossed paths and had a lunch he his wife and I. He excused himself to go to the bathroom during our lunch. While he was gone his wife became very somber which is not her personality at all. She told me "Everything you said came true" she was going to stick with him and support him but there are easier gigs as a doc than working in an ER, they both knew that now. I didn't ask for specifics, i could see the change in my friend too and it made me sad.

I knew one ER doc who was fucking excellent. She was amazing with the patients, staff all the way down to the housekeepers and kitchen personnel. It was a fair sized hospital and everyone it seemed knew her. Plus she was a great doc to boot. We loved her, she got tired of the grind of being an ER doc and one day came in told the group she was working with that she was done and left to do public health in Africa. She sent us an email a year or so later telling us it was the best decision she ever made.

I'm probably sticking my foot into my own mouth rattling off about this but really there is an easier way to make a living with an advanced degree, I'm sure of it. For the most part everyone who works in an ER intentions are well, they have a good heart. There are a lot of lost souls who work in an ER and I'm always a little depressed when I see a new crop of ER residents or new grad nurses come into the department.There is a high mental price to be paid in order to do it though.

For those of us who were lucky to get through high school and go on to work on an ambulance after a few years it's all you know. Your career options are limited dragging drunks and junkies out of flea bag motels and out of the gutter makes for great stories but hardly pays the bills. Ambulances and hospitals are not happy places in general. What I am saying in my off kilter way is:

Don't do it.

What do I know, I'm just Crusty ER Tech.