When I had spoken to his family earlier, I learned that the man did not wish to be resuscitated. So there I was with my hand on his chest, one eye on the monitor and one on his wife. A classic v-tach wave form clipped along. The family was remarkably calm. Normally, I like to have more than 20 seconds to decide whether to resuscitate a suicidal man who has stated in writing that he does not desire what I have to offer.

There was no time for an ethics consult, or even to run through the ethical ABCs. On one hand, I thought that he had been treated for his overdose and this was a separate, but tangential, issue. On the other, I felt that there was a direct relationship to his suicide attempt. On one hand, there was patient autonomy, and on the other the caveat about wanting to commit suicide.

Intellectually and ethically, I could have gone either way. I asked the family what they wanted to do.

After a brief discussion, they asked that I let him die.

The patient died soon after, and the coroner came to see him because he was already there investigating a cardiac arrest from a few hours before. I read the man's obituary in the newspaper days later.

I thought about both of these events, and I came to the conclusion that, even though emergency medicine has been a specialty since Carter was president, people (and doctors) still have no clue about what we do.

How strange it was to have to deal with someone spitting mad over waiting an extra 5 minutes to be seen for muscle pain, and soon after that having to make a life or death decision in the time that passes to take a deep breath.

Emergency medicine has been, on many levels, an enormous medical success. What specialty would not want the explosion of patient volume that has occurred in the past 20 years? Except for the part about nobody having to pay, emergency medicine is a winner on all counts.

The public knows very well that even if they have to wait, we deliver fantastic care.

Something hasn't been conveyed well enough, however, when many people (and doctors) still don't understand that a wait for many of the patients we see is a microsecond. It means nothing.