After the shift ends, the distress doesn’t remain in the emergency department. It follows us into the silence as we walk to our cars, through the drive home, and settles in as the pace drops after hours of constant motion. The tension isn’t always tied to the hardest cases or the worst outcomes. Sometimes it’s there after a shift that, all things considered, went well. It shows up as replaying decisions, second-guessing, scanning for what might have been missed, a quiet but persistent sense that something could have been done better. By the time the day is supposed to be over, it feels like it’s just beginning.

In emergency medicine, we tend to explain distress in terms of what we see. Difficult cases. Bad outcomes. Fractured bodies. Patients too sick to save. Families left trying to make sense of what just happened. We tell ourselves this is what we carry home, that the weight comes from the pain we witness. There is truth in that. Our work is intense; the human cost is real.

I once believed that. It made sense. The cases were demanding. And the things I saw were not easy to hold.

But over time, I started to notice something that didn’t quite fit. Distress didn’t always match the cases. The unease could still be there even when the shift seemed fine. That was harder to explain. What affected me more consistently wasn’t just what I saw. It was what the work brought up in me. The emergency department didn’t fully explain those feelings, but it seemed to intensify them. And when the shift ended, there was no clear place for the discomfort to go.

I had to make those feelings go somewhere.

Sometimes I used movement. Pushing the body hard enough to settle the mind. Other times, I over-functioned. More work. More productivity. Staying busy so there was no space left to feel. And in some instances, I disconnected. I created distance from anything that might bring the feelings back up. There were periods when I told myself I just needed something to take the edge off. A drink. A pill. What began as a way to quiet the noise gradually became something I relied on more than I wanted to admit. Reaching for relief didn’t feel like a decision. It felt like survival. A way to get through the end of the day.

The pattern didn’t feel dangerous. It felt effective. And for a little while, it was. Gradually, the brain learns what quiets distress and begins reaching for it more quickly. Automatically. Not because we’re weak, but because the brain is doing exactly what it was designed to do.

It’s not just about what we’re exposed to, or even how much we can handle. It’s about what this work brings up in us. If distress has nowhere to go, it will find somewhere. And the ways we find relief will make sense in the moment, even when they come at a cost. In my own life, what once felt like survival gradually became another source of suffering. Eventually, I needed help learning how to process distress rather than continually avoiding it.

Recognizing this pattern may not eliminate it, but it can change how we respond, both during and after the shift. It creates space to notice distress before we automatically reach for relief, and to seek connection, reflection, or support before the coping itself deepens the pain we are trying to escape.

Dr. Seefeld is a board-certified emergency physician and addiction medicine specialist. He serves as medical director of the emergency department at Speare Memorial Hospital, associate medical director of the New Hampshire Professionals Health Program, and clinical assistant professor of emergency medicine at the University of New England College of Osteopathic Medicine. His work focuses on how people respond to distress and the patterns that drive relief-seeking behavior. He is the author of The Fire I Fed: From Ashes to Awareness.