On a recent shift, I cared for a stroke patient with a story that, on the surface, was one that we hear all too often in Emergency Medicine.
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ACEP Now: April Digital 02-D“Mrs. A”, as we’ll call her, arrived hypertensive and aphasic with a hemiparesis and left-sided neglect. Family told EMS that she had no known past medical history, yet the paramedics suspected that she likely hadn’t seen a doctor in many years. It wasn’t that she had no medical conditions. It was simply that her medical conditions were undiagnosed. As the story unfolded, it was a little more complicated than that.
Just over a year ago, Mrs. A and her family immigrated to the U.S. from Indonesia, and she did not speak or understand English. She had yet to be seen in any health care setting in the U.S., and, quite likely, she had never seen a doctor in her entire life. Now, in her early 50s, a lifetime of medical neglect pushed her headfirst into the devastating consequences of an undiagnosed and untreated chronic condition—a hemorrhagic stroke caused by long-standing, untreated hypertension.
My heart ached for this woman and her family, knowing that she would likely never fully recover, and that her devastating diagnosis could have been so easily prevented had the most basic medical care been available to her.
The Pandemic, Burnout, and the Search for Meaning
As many of us can relate to, the moments that I love most in my career are the ones when I feel like I truly made a difference to a patient and their family. However, those moments are farther apart than I wish they were, and the day-to-day challenges that our specialty faces often take the forefront, now more than ever. We continue to battle the weight of hallway beds (or chairs) bearing the brunt of the boarding crisis, seemingly endless and growing gaps in specialty coverage, and ever worsening administrative demands taking more and more of our time.
In the wake of the COVID-19 pandemic, it can be challenging to admit what the statistics and our experiences clearly reveal: frontline workers in our specialty bore an outsized share of the burden. We witnessed suffering on an unimaginable scale, and stretched our limits until the very fabric of our profession began to fray. The center of what brought so many of us to the field in the first place, to help people, could not hold.
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One Response to “Rekindling the Fire in Emergency Medicine”
April 27, 2025
Thomas Giberson, DO, FACEPIt is impportant to realize what a great honor it is to care for those who need us. If we live our lives accepting that honor,then we don’t need the outer gratification any more. what is missing in Emergency Medicine is the time to connect to our patients. I would suggest picking up a few shifts in Urgnt Care clinics. Yes, it’s seeing runny noses, etc, but it is also diagnosing Avute liupus nepritis and pulmonaru edema. Our skills developed over a lifetime of emergency care can help to pick up subtle findings FP’s would miss. I expect evey room I walk into has someone in it just waiting to die. It’s the acute meningitis that looks like every other URI, or the PE when everyone has a URI. We KNOW those people and know how to find them. When demanding the opportunity to connect with people we can exercise the cution we were trained to use. That is the voice of 43 years of Emergency Medicine in high volume-high acuity care. Burnout, which I have also experienced, is coming out of every room thinling we hate people. It is no more than transfering the inner suffering we feel by being pushed too far too fast to make money for someone else. Each of our patients become an invisible curse who are named illnesses rather than an MIT graduate engineer or crust 45 year old woman who is a train conductor and serves as the engineeer for return trips, the 17 year old woman who is a diesel mechanic, or the illiterate 75 year old who worked his butt off who has been married for 55 years and put all of his children through college becaue it was a goal too farr for him to ever reach. Go to another country and see the desparate lives people live because they have zero opportunity or care for the peole here who are given the opportunities and spit on that opportunity. Either way, you can still find the gratification kn owing it is an hoor to care for people who have zero opportunity. The cause of our suffering is not outside each of us, it lives within ourselves. We are honorable men and women of courage, integrity, deep compassion, and commintment who see, know, and feel too much while being pushed to do more with less time (half of which is documentation) for sicker, more vulnerable, patients who have become society’s throw-aways. You go to work to care for the homeless, addicts, alcoholics, irreponsible people – thos who need us. You see and feel the children beaten to death, or young mothers who are dead because of a drunk driver, and the elderly who are dumped in a nursing home to become wards of the state. And when it is donme, at the end of the day, we ask ourseles “what the hell was that about?” Our souls are depleted by those who try to drag it from us. But we go bak to work the next day. And going back each day is an act of great compassion because you see the need and have the drive to meet those needs. Take great pride in that, becaause it is a great honor to be given the chance to exercise that compassion. You have the gift of being able to do what we do and it has been an incredible honor to have worked along side sme of you.