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» Comrades in the Trenches

Comrades in the Trenches

I truly relish and enjoy my conversations with fellow ED docs about our days.  Sometimes only colleagues who do exactly what you do and see exactly what you see can truly understand what a day in this life is like.  While we are constantly surrounded by patients, nurses, secretaries and techs, it is amazing how isolated one actually becomes in a solo ED pit.  The isolation certainly can not compare to radiologists or pathologists who rarely have patients speak to them, (unless someone prematurely pronounces death, or they’re hallucinating). But who can feel bad for them, they seem to prefer it that way.  Nobody screams at them, threatens their safety, or manipulates them into dispensing narcotics all day long.  And they make a lot of money.

What can be tough for us as ED docs is that most of us are very social by nature, and we like to speak our minds, which is not always appropriate.  This is true of any profession, but in the ED there is so much happening and crossing our visual fields every moment of the day that the dichotomy between what we say and our internal dialogue can be gynormous.  It takes true self restraint not to say, “what the hell were you thinking”, or worse, at least 5 times a day.  I still say it with my eyes and eyebrows sometimes, and fortunately that can not be quoted in a patient complaint letter.  It is a true art to sympathetically look a patient in the eye while fully realizing in the first minute of the encounter that the next 10 minutes will be a complete waste of your 15 years of education because a half blind 1st grader with ADD can tell that little cut doesn’t need stitches, just some neosprin and a band-aid, thank you very much.

The only time we can really let it all hang out without fear of judgement or reprisal is with other ED folks.  Everyone else sarcastically says or thinks, “oh great bedside mannor doctor”.   Well guess what, I learned what great bedside manner really is… it is listening intently when the information is important, and thinking about what your going to have for lunch when people ramble on about dumb stuff so you still look interested.  Oh I hear it, I hear it all, but instead of giving the natural look one should have when thinking, “I can’t believe you just told me your feces floated today but sank yesterday….and wonder what it means because so did your dad’s” the look is “hmmm that’s very interesting” while the thought is, “you crazy fool, you probably both ate the same food, but it really doesn’t matter because you’re here for an earache!”.

Now admit it, your first reaction is, “oh my goodness, that’s what doctors think when patients tell them really personal stuff”.  Well, this is just the tip of the iceberg.  Imagine the internal dialogue when caring for malodorous, disheveled, rude, patients who think it is appropriate to urinate on the waiting room wall in front of young children.  Only a comrade in the trenches understands what it means to put on the poker face, take these “medical emergencies” as seriously as is warranted, and still maintain a degree of sanity in one’s life.  So I salute everyone who has joined this illustrious club, and if we have nothing else we have a career full of the most interesting, profound, and sometimes amusing human interactions imagineable.

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