In the wake of a harrowing year, I’m left wondering: Is a career in emergency medicine worth it? Like so many of my colleagues, I suffered personal tragedies during the pandemic that exacerbated the incredible stress at work.
My brother died in March 2021, 3 weeks after receiving a diagnosis of metastatic colon cancer. Just 6 months later, my mother died unexpectedly.
I have no doubt that emergency medicine doctors, in general, are exceptionally resilient. I certainly thought of myself that way, but my mom’s death broke me. I felt physically ill for months afterward, and even minor stressors sent me reeling.
I shared with one of my colleagues how severe my anxiety had become, and she gently recommended that I take advantage of the therapy services provided by our hospital.
In addition to attending regular counseling sessions for the first time in my life, I started antidepressants.
Now from a much healthier headspace, I’m reflecting more objectively on the impact of my occupation on mental well-being.
“Rage Absorber”
Obviously, the past couple of years have been extraordinarily stressful, but our specialty had one of the highest rates of burnout among physicians well before the COVID-19 pandemic. In 2019, less than a decade after completing residency, it was clear to me that working full-time as an emergency medicine doctor would not be sustainable in the long term.
Yet emergency medicine always seemed to be the perfect fit for me: I can problem-solve quickly, I value variety, and I welcome a challenge.
Nonetheless, the work I used to love is starting to feel soul-crushing. Dealing with relentless volume overload and understaffing every day is taxing, to say the least.
Then there are shifts during which I feel my major role in the department is “rage absorber;” I’m expected to control my own emotions and reactions while being on the receiving end of back-to-back verbal lashings from unhappy patients and rude consultants.
Luckily there are some solutions and — spoiler alert! — they’re not required wellness initiatives or free yoga. Emergency departments (ED) could employ more patient advocates and social workers to take on some of that rage-absorber role.
Administrators could elicit feedback and work hard to incorporate it. Ideally, consultants would consider how different our environment is from their own and show some patience and grace in their interactions with us. These are a few of the solvable nuisances that would substantially improve workplace wellness.
Glorious Lightness
Personally, there are two troubling stressors I’ve identified that feel inherently part of the specialty and thus insurmountable.
The first is the lack of attention and treatment given to the emotional trauma healthcare workers experience, especially in the ED.
While listening to NPR one morning, I heard an army medic attribute his PTSD [post-traumatic stress disorder] to the inability to save a wounded soldier during combat. Clearly, I’m not under fire on a battlefield with minimal equipment at work, so I’m not comparing my situation to his.
But I can empathize because, no matter how smart or resourceful I am, some of my patients will die (or worse), and that can be heartbreaking and traumatic.
What’s more, there’s no time to process my emotional response when a bad outcome does occur as I scramble to catch up afterward, often dealing with patients that are angry about the resultant delay in their care. I’m sure there are other specialties that can relate to this experience.
Stress, more specific to emergency medicine, results from the expectation that we must always be prepared for any type of disaster.
Over the past half-year, my therapist, Tessa, has helped me understand that my raging anxiety was in large part due to the huge amount of time I spent working through worst-case scenarios in my head. My mom bled to death in her home because she was on a blood thinner and sustained an injury while she was alone.
Realistically, there’s no way I could have prepared for or prevented that particular outcome. Still, in the months afterward, I spent the better part of my waking hours imagining the moments leading up to her death.
Even worse, I began to worry endlessly about the various catastrophes that could befall my family. Tessa helped me realize that I was expending a colossal amount of energy and time this way without gaining anything.
I’ve learned to acknowledge when I’m feeling afraid of a situation that I can’t control — and then to move on. Relieving myself of all that responsibility left me with a glorious lightness and has enabled me to be more present in my day-to-day life.
In my sessions with Tessa, I repeatedly wondered if my training as an emergency medicine physician had something to do with this maladaptive coping strategy I’d developed. A large portion of our knowledge base is disaster response, maybe to the extent that the pressure to deal with low likelihood, high-risk events or pathology inevitably seeps into our daily lives.
For example, emergency medicine lecturers will not uncommonly recommend purchasing equipment like tourniquets, tools for intubating, and handheld ultrasounds to have at home or in your car “just in case.”
We’re encouraged to mentally rehearse life-saving procedures for conditions that occur so rarely we might go our entire career without performing them. And the reality is that I could spend every minute of my free time this way and still have an unexpected situation arise during my next shift. So is there a way, as experts in disaster preparedness, to accept what we cannot control?
Thankfully, time, medication, and therapy helped me out of a very dark place, and the journey has prompted me to reconsider my priorities. Tessa and I only meet about once a month now. With her continued help, I’m hoping to find a way forward in the specialty I love, but with the understanding that I’m no longer willing to sacrifice my own mental wellness.
Adrienne Van Curen, MD, is an emergency medicine physician.
This post appeared on KevinMD.