When you eventually get around to re-evaluating the patient, you realize that she has a decubitus ulcer which resembles a dachshund covered in 10 pounds of seaweed. Her temperature is now 103, her heart-rate is 157, and her color has a distinctly Yoda-esque quality.

“Looking? Found the source you have, hmm!”

Rule 3: The enemy of good is better.

The patient with the sprained ankle had a pressure of 220/110. Now she has a pressure of 178/110 and is feeling fine. Good, send her home. You don’t need to make that better. Put that clonidine back in the Pyxis. She does not need a pressure of 85/22.

This is not permission to be lazy. If a pressure is tanking, put in the central line and get moving. But in that patient you have worked up for his hyperglycemia, keep your wits about you. He came in with a glucose of 454. You gave him fluids and checked for DKA and everything is negative. His glucose is now 302. Great. He has close follow-up? Wonderful. Check old records and you find out that is the lowest his glucose has been in two months. Great. He is good. You can put that dose of insulin next to the clonidine in the Pyxis.

Rule 4: Leave your garbage outside.

The importance of positivity cannot be understated. Leave whining at the door and come in spewing positivity like a variceal bleed of joy. If you are feeling especially Eeyore today, throw on a smile and fake Tigger to the best of your ability. No patient you see started their day planning to do be in the emergency department, unless they’re looking for drugs. (But that happens only on days ending in “day.”) She wasn’t planning to have severe lower abdominal pain. She did not wake up thinking, “Oh, boy. I hope I can sit in a horrible gown, in pain, being examined by a stranger).” No matter how bad your shift is, your patient’s day is usually worse.

I love whining about my job. I love to pontificate with glorious embellishment about various interactions. Get a group of ER docs together, and they will start trading war stories in under four minutes. It happens every time. Do that at home and be uplifting at work.

Rule 5: Let it go.

This might be counter-intuitive to the newbies out there. This does not mean to ignore abuse or people in agony. No. This is advice to stop helping people when help isn’t needed.