Letter from the Editor

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Every year as interns don their long white coats for the first time ever, swipe their glossy name badges, and figure out where the bathrooms are, I have flashbacks to my first few shifts as a “real doctor” in the emergency department. For the most part, I knew what to expect: to constantly feel sick to my stomach and completely overwhelmed, while wondering what I had actually learned in medical school. And while I found it simultaneously liberating and terrifying to be able to write orders, make medical decisions, and perform procedures that I had only dreamt of as a medical student, I was disheartened to discover a much darker side to medicine.

No, it wasn’t the endless administrative tasks, the nagging fear of litigation, or the waning empathy. It was surprisingly the way physicians treat each other.

One day I found myself fighting back tears in fluorescent bathroom lighting after having been mocked and berated by the chief of a consulting team. As I stared at myself in the mirror, desperately trying to wipe off what remained of my mascara (wasn’t this stuff supposed to be waterproof?), a nurse was calling my phone for a medication order. My pager was beeping with another Level 1 trauma. Just 30 more seconds and I was expected to walk out looking fresh and eager, excited to rejoin the educational utopia that was the ED. More like a war zone, to me.

In that moment, I could not have felt more alone.

Yet over the years, instead of asking why these attitudes exist, I found myself simply accepting them. It was easier to excuse rude or condescending behavior by rationalizing that these so-called “colleagues” were overworked, or sleep-deprived, or that their personal lives were falling apart. It was much more difficult to accept that certain behaviors might just be the result of inherent feelings of superiority.

Sometimes we don’t see eye-to-eye with our colleagues. This can create an “us vs. them” mentality that stems from a more primal need to identify with and stay loyal to a certain social group or community. But emergency physicians interact with more physicians in more specialties on any given day than anyone else in the hospital. We simply cannot afford constant clashes between our “social” groups, or else we risk disgracing the entire profession.

What we too often forget is that every single doctor provides an important aspect of patient care that complements the work of others. We need our primary care colleagues to continue working hard to keep their patients out of the hospital. We need our surgical subspecialists to be able to take patients emergently to the operating room, something far beyond our own scope of knowledge or practice. And they need us to care for their patients when they are not available, 24 hours a day, 365 days a year. Like well-trained professional athletes on an Olympic crew team, every person is integral to the stroke of sound and safe clinical practice. In order to succeed, we must truly believe that we are all equally important. We are all in the same boat, after all.

Last month, I delivered a very premature neonate in a community hospital that had neither pediatrics nor obstetrics. Like a brand-new intern, I was simultaneously exhilarated and terrified. At the end of the shift, however, the adrenaline rush had dissipated and it felt like just another day at work. That is, I had simply done what I was expected to do.

Three days later, I received a call from the neonatal ICU attending at the children’s hospital, commending us on our work. Three specific words rung in my ears like the Liberty Bell: “I appreciate you.”

This recognition by a physician I had never met, but with whom I shared a very special patient, trumped every negative interaction from the preceding months — maybe even years. Unbeknownst to that physician, in that moment, those 3 words made everything seem worthwhile.

Each time I prepare another issue of EM Resident, I am astounded by the breadth of knowledge and experience of my colleagues. It saddens me to think that somewhere out there, hiding in a bathroom, is a resident who feels as though they have given so much of themselves for so long, yet seemingly for so little in return. Whether s/he is a fellow EM resident or an orthopedic consultant, let that resident know how much you appreciate them. I promise it will make their day.

Abby Cosgrove, MD

Abby Cosgrove, MD

Editor-in-Chief, EM Resident, Washington University in St. Louis, St. Louis, MO
Abby Cosgrove, MD

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