BOSTON—Maybe the greatest lesson that Al Sacchetti, MD, FACEP has learned in 35 years of emergency medicine is duality.

Emergency physicians need the empathy to understand a patient’s fog of fear and the heartlessness to immediately stab them with a needle because it’s the correct clinical call. They must accept the black hole that is, “I feel dizzy,” while being supremely confident that the pain of hyperpronation is the best way to fix that nursemaid’s elbow.

The sadness of death in Exam Room 1, the joy of a benign tumor in Exam Room 2.

“Emergency physicians are the only area of medicine where you get to experience the entire spectrum of human emotions in a single shift,” said Dr. Sacchetti, who delivered ACEP15’s James D. Mills Jr. Memorial Lecture Tuesday morning to a packed room and a standing ovation. “You go from the highest of the highs…to the lowest of the lows.”

Dr. Sacchetti, chief of emergency services at Our Lady of Lourdes Medical Center in Camden, New Jersey, and assistant clinical professor of emergency medicine at Thomas Jefferson University in Philadelphia, said during his lecture—“Lessons My Patients Have Taught Me: Humor, Humility and Humanity Learned at the Bedside”—that balancing humor and seriousness, the need to be supporting and the desire to be supported are all part of the business of being an emergency physician.

“Sometimes you have to make the wrong decision to get to the right answer,” Dr. Sacchetti said. “You’re going to come across paths where you can go either direction. You can’t keep straddling that bifurcation too long…there’s so many people in medicine who can’t do anything because they’re afraid to make the wrong decision.”

Dr. Sacchetti said wrong decisions, patient deaths, and the rote frustrations of every emergency department shouldn’t overshadow that emergency physicians have a unique opportunity to make an impact with every tug of an exam room curtain.

“When I leave here…I have a shift to do,” Dr. Sacchetti said. “I’m going to walk in there, I’m sure there’s going to be patients boarded in the hallways. There’s going to be some email from somebody whose patient ended up on the wrong service. There’s going to be a waiting room full of people. And I’ll wade through it.

“I know that the end of that shift, when I leave, there will be somebody whose life changed because they had an emergency physician there to take care of them.”