What I love most about emergency medicine

The other day, someone asked me what I love most about emergency medicine. And I realized that it was completely impossible to provide a concise answer to that question. I could talk about how much I love ER all day. Every day. But I decided to challenge myself and see if I could adequately summarize the things I love most about being an emergency veterinarian. I threw some words against the wall, and this is what stuck: 

  1. The thrill – and serenity – of not knowing what will happen next. 

I am super type A personality by nature. Starting in kindergarten, I would lay out my clothes to wear to school the next day. I always got my homework done on time, and regularly asked for MORE homework. I would freak out if I was 5 minutes late for anything. So one would think that an emergency setting wouldn’t really be congruent with my personality type. But somehow the opposite is true – it actually gives me more anxiety to have an appointment schedule. If you have a schedule, people expect you to be on time. So if you have a sick patient that takes up more time than you expect, you will be late for the next appointment, and it snowballs throughout the rest of the day. 

If you are a general practice veterinarian, you will have a short description of your appointments – such as “not eating for 3 days.” So you might sit there and stress about what is wrong with that patient and how that appointment is going to go. But in an emergency setting, you never know what is going to happen. It’s hard to get anxious about something if you don’t know what’s coming. You just have to take things as they come at you and just surrender to the fact that you don’t know what the ER will throw at you next. I understand that for some people, this may cause more anxiety. But for me, for someone who likes to plan out her life literally 10 years into the future, ER helps to keep me in the present. It forces me to narrow down my focus and prioritize what needs to get done. 

For me, not knowing what will happen next is both exciting and peaceful. It keeps me grounded and forces me to stop worrying about things I cannot change, and to instead focus on the here and now. 

2. It is intellectually and emotionally challenging. 

Emergency is challenging from so many standpoints. It requires critical thinking when patients do not have a straightforward diagnosis. As an emergency doctor, I am not a specialist in one particular area. I am required to be a jack of all trades. I am constantly reading textbooks and journal articles to refresh my knowledge or to find the latest studies. And I get to do a little bit of everything when it comes to procedures – abdominal surgeries, endoscopies, laceration repairs, chest tube placement, thoracocentesis and pericardiocentesis, placing feeding tubes, relieving urinary obstructions, and running CPR. 

You have to come up with the best diagnostic and treatment plan, and often this has to be done within financial constraints, which presents its own challenge in and of itself. Do I want to spend money on another diagnostic, or allocate funding for treating what I think is the most likely diagnosis? Do I want to give this medication, or is there another medication that is less expensive but might still be as effective?

And then there is the emotional challenge, which is a whole different beast. Emergency requires an extraordinary amount of patience and forgiveness. The most challenging thing for me has been learning not to make judgments and not to take anything personally. When someone is in the ER with their pet, they are not likely to be the best version of themselves. It may be the middle of the night and they may be exhausted, they may be worried about their financial situation, there may be any number of other things going on in their personal life, and most of all they are scared about their pet’s health. 

I constantly have to remind myself not to internalize feelings of anger when someone gets upset with me for one reason or another. Instead of getting offended if someone is upset, I turn the focus back on the animal. I have found that as long as you remind owners that you are there to help their pet feel better, they respond well, and emotions can stay in check. 

3. The schedule. 

Most people would think that this is a negative aspect of being an ER doctor. But I think it’s actually the best part. Have you ever been completely alone in the middle of the woods skiing on a weekday? Have you even been to Costco when there are no lines or crowds? It’s the freaking best. I love having weekdays off. 

And as crazy as it sounds, I actually like working holidays and overnights. Yes, overnights are incredibly tough on my body. But getting to be the person who is there when there is no one else around is the BEST. People are so appreciative that there are veterinarians who sacrifice their sleep or their holidays in order to provide care to their animals.

4. The camaraderie.

To work in the field of emergency medicine, you have to have a certain personality type. You have to have a big heart and really care about what you do. You have to have a sense of humor. And you have to be a team player. 

When you see someone else drowning, you help pick them back up. You tackle the small things. There is no task that is beneath anyone – I don’t care if you’re a doctor, you can still help clean up accidents and walk dogs just like anyone else would. Whatever you need to do for your team, you just jump right in and do it. 

5. Being a hero.

This is hands down the best part of being an emergency doctor. How many people get to say they saved a life (or lives) during their work day? Not many. There’s nothing better than treating an Addisonian crisis, tapping a pericardial effusion in tamponade, or stabilizing a polytrauma patient. And the feeling of sending a patient home with their family is pretty unbeatable. 

The tough part about being a hero is that you don’t always win. We can’t save them all. We can, however, alleviate pain. And in my mind, that is still heroic. Yes, every euthanasia is difficult. Some more so than others. The amount of death that we are exposed to is tremendous. But sometimes that’s what it means to be a hero – to be the person to end suffering, the person who helped an owner make the best decision for their pet, who made the process peaceful and quiet. 

People won’t remember what you said or what you did. But they will remember how you made them feel. They remember the people who calmed them down after their pet was hit by a car, and they remember the kindness with which they were treated when they lost their animal. They remember the heroes. And we have the privilege of being a hero to people and their pets every single time we step foot into the ER. 

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