When the wizard has been revealed, and he must make good on his promises, he brings out a big bag. He tells the Tin Man that he is no different than the good-deed doers the wizard knows back home. “But they have one thing you haven’t got: a testimonial.”

He gave the Tin Man a large heart with a ticking clock and said, “And remember, my sentimental friend, that a heart is not judged by how much you love, but by how much you are loved by others.”

Sometimes I feel like emergency medicine is the Tin Man specialty. Our commitment and our capacity for caring know few boundaries—yet at times I feel an emptiness, or that feeling of being the outsider looking in. I think that often what is missing is that affirmation from patients and their families.

In New Orleans, a man brought me a bottle of Dom Pérignon for intubating him when he was in heart failure. This was a wonderful gesture, and I still have good feelings about it today. That kind of positive feedback and sign of appreciation, however, is rarely seen in our specialty.

This doesn’t mean that people don’t appreciate what we do. They just don’t have an easy way to do it. If we saw people in follow-up in the office 2 weeks after reducing their dislocated shoulder, we would get lots of smiles and pats on the back. The smiles we get in the ED are usually related to the conscious sedation.

We are like the Tin Man in the sense that we forget the good things we do every day and fail to realize how much we are appreciated. The appreciation may go unstated, but I know that patients and families have good feelings about us. We are loved, and the fact that our good deeds don’t accumulate in a small number of people who come to visit us again does not diminish our virtuous acts.

Stand tall. You don’t need a testimonial to hang around your neck. Your testimonial is the patients who come in severe pain and find relief, the child who experiences suturing without fear, the homeless man who finds comfort and understanding, the families who find a strong shoulder to lean on in their worst grief, and the elderly woman from the nursing home who is treated with the same care and respect given to a baby.