Dear Patients and Families: Have Mercy on my ER Family

They're doing their best...

Although I have one main job as a physician I do work in other locations as well. For those not in medicine, this is referred to as “locums” or “locum tenens” work. It’s an old Latin word meaning “to hold the place of.” And in medicine it means to work part-time or temporarily while there are openings in a hospital. For perspective there are a lot of openings now. Physicians of many specialties are needed but not available in many hospitals and various communities. I actually work part-time in one system that has 100 open ER physician shifts every month between a few hospitals.

That’s rough because what we don’t have any looming shortage of sick or injured people.

I say this all by way of background so that my credentials are clear. I speak not about one hospital or one system. I feel like Johnny Cash. “I been everywhere man…”

“I been to Bluefield, Princeton, Highlands and Toccoa; Murphy, Bremen, Owenton, and Manning; Craig and Kremmling, Robinson and Sterling. I been to Hilton Head, Greer and Simpsonville and Hampton; Seacoast, McLeod and Coastal Carolina….” (It’s better if you hum the tune…).

I have experience from hospitals large and small, urban and rural. I have worked in over 40 hospitals in the last 11 years and those people I worked with remain my ER family. (Hey team, how’s it going! I miss you!)

So what I want to do today is to speak for my colleagues.

No, I want to speak for my work family.

At my job I am often referred to as “ER Dad.” I take that seriously. I care deeply for the people who are my “ER kids” or “ER family.” I try to keep them on the straight and narrow (what a job!). I want them all to be safe, successful and happy. I mean this locally, of course, but I also mean my fellow ER people around the country and around the world. These are my people. My tribe. I care for them. In fact, I have written columns for that tribe for 24 years.

When I refer to my work family I’m talking about the men and women who endure the difficult work of the emergency department. Well, old people like me call it the emergency room. It’s a rather academic discussion within the specialty so ignore it.

My work family includes physicians and nurses, physician assistants and nurse practitioners, secretaries and ER techs, paramedics and EMTs. It includes the respiratory therapists and Xray techs, lab techs and phlebotomists and all of the others who populate my world and help me to do my job. More important, who do their best to help sick, hurting humans to get better; or at least feel less pain.

Lately I have sensed a growing frustration at work. Now, I’m used to frustration among staff-members, who are usually over-caffeinated and under-rested. Everybody feels overworked and stressed. It’s a hard job on a good day. Over the years I’ve heard many a busy professional say “I hate people!”

To which I say, “Nope. If you did you wouldn’t be here. You hate the situation.” They typically agree.

However, what I see now is an exploding frustration among the patients we see and their families. Honestly, I get it. I mean, we’re busy. Really busy.

Autumn is upon us. In my experience it’s the time when the typical injuries and tragedies of summer give way to the colds, flu, pneumonia and other contagious predators of fall and winter.

I used to say that summer killed like a viper, quickly and unexpected, but winter like an anaconda, squeezing the breath from the living. I stand by that. Although there’s often a little lull between seasons. It’s like the angel of death goes to Cancun for a week or two and we can chill. This year I haven’t seen the break. (I mean, who can afford travel anyway? Even non-human beings are feeling the pinch.)

Maybe in part it’s because we’ve had more COVID and the cold weather afflictions are coming earlier and overlapping the assorted lacerations, ATV crashes and all of the other madness of the heat of the year.

I have written ad nauseam about the state of our hospitals. You may be tired of it; if so please say so in the comments. We have far more complex sick people than we have rooms, specialists or resources. Like all complicated issues there’s neither simple cause nor simple solution. But the bottom line is that people are sick, frustrated and frightened. They’re also exhausted. Humans are tough but after a while even the strongest gets worn down from being ill and simultaneously fighting the system. Many are worn to a frazzle by caring for their family members; particularly the old and frail they treasure but who can be time and labor intensive.

Our patients across the land (and in other modern countries as well) struggle to find a doctor. Yes, it’s even a problem in national health systems. Nothing’s perfect after all. People struggle to find a hospital bed to lie down and rest from their vomiting. They wait in the ER for days in order to be admitted. Their medications, including chemotherapy agents, are in short supply. Their insurance companies deny the things they need. They read the news and worry about COVID. They worry about the election. They worry about the addicted and mentally ill that cross their paths on the street, or in their yards. They worry about their loved ones who are addicted and mentally ill. They worry about feeding and educating their children. There’s a lot going on and I fully understand.

But what I want to say is very simple. To all of those family members who are angry, to all of those in the packed, exploding waiting rooms, hallway chairs and ER beds, to all of those sick, hurting and trying to get medical care but frustrated by long wait times…

Please understand and try to be kind to my family.

All of us in healthcare, and especially in the madhouse that is the modern ER, are fighting very hard against an overwhelmed and overwhelming system. We’re struggling against laws and rules that we have to follow, against faceless, heartless corporate practices, against shortages of the things we need and against the hard fact that ERs and hospitals have a fixed capacity.

Daily we try to balance the care of the suicidal young woman against the care of the person whose lungs are filled with infection. We try to split our time between the heart attack and the very painful, very real ankle fracture. We do our best to move people so that beds are available, and to give care in whatever settings we can; whether waiting room or hallway chair.

It’s easy to get angry. But just as the clerk at the airline counter doesn’t control the weather, there are things we in the ER can’t control. We don’t choose how many people come to us, we can’t control who sends them to us, what happened to them in the first place, what infections are circulating, what supplies we have on hand and or how many specialists we have available.

And we certainly don’t control the number of beds available in the hospital, or when they are available.

My ER family tries its very best to treat pain, rescue people from death, treat infections, make everyone comfortable and get them blankets, remote controls, turkey sandwiches and Sprite, the official meal of the ER. (Pillows are nearly mythical. I saw one once; Bigfoot was carrying it away.)

My ER family tries to advocate for their patients to get care as fast as possible, whether locally or when transferred out of town. Sometimes they do it in the face of threats or actual assault. Frequently my work daughters/sisters do their jobs in the care of creepy men who say things like “hey baby-girl, you need a boyfriend…” and who then try to touch them. Gross. They would do well to remember that these ladies are tough and fearless…

Sometimes my family is working in conditions that are pretty close to what you might see in a disaster. And doing it all night and day, in all weather. They’re hungry and thirsty too. They’re worried about their husbands, wives, children and bills. They’re concerned about infections. And also about complaints and lawsuits and licenses and all the rest.

So I hope you can avoid visiting my ER family. Nobody wants to be there because it means something is wrong.

But if you have to be there, just show my family some grace. Because when the chips are down they’ll work themselves to exhaustion to take care of you and the people you love.

That has to be worth something…and if nothing else, it’s worth kindness in the face of all the chaos.

ER Dad