The thing is, I LOVE heart attacks!
I know this is a weird statement, maybe even a little overstated. I know that people can get uncomfortable when I say this. When I said it for the first time, full of enthusiasm and with sparkling eyes, my ex-fiance looked at me in a concerned and puzzled way: ‘Can you say that?’ – He asked, wondering if it was appropriate for a doctor to say that they actually enjoyed the experience of people being so unwell.
Clearly, as a doctor, I have nothing against people. Quite the contrary, I unceasingly fight for them to survive and thrive. Yet the paradox is real, despite my battle to save my patients, I am so in love with heart attacks!
Why? Perhaps I love the puzzle behind it. When the patient arrives, I see the position of the body, the hand on the chest, fingers tightly pressed against the skin, the skin color, the sweating… I consider the nuances of pain types, the comorbidities, the risk factors… All are informing my judgment and decisions even before I get to look at the ECG.
I love knowing the diagnosis as it reveals itself. I love that I can treat it. And when it works, I’m the queen of my craft. The scores of survival game change. 1 for me, 1 for my patient, and 0 for the heart attack!
So that’s why you would see me so happy when a patient arrives in my ED. I love this feeling. I love this adrenaline rush that is emergency medicine and me! I love leading a code, guiding actions, organizing my team to the point of ROSC. I love that roaring energy that runs through the whole team as we effortlessly move to the next stage of resuscitation.
This is why I love Emergency Medicine.
Emergency Medicine is new In Brazil. The general assumption is that ED is where junior physicians serve until they choose another specialty or other specialists work to earn additional income. Until recently, working in the ED was a difficult job with no career advancement. So, when I realized that I was so in love with more than heart attacks that I could not leave my work as an Emergency Physician, people started to ask me, “Are you sure? Do you want to work forever in an ED in Brazil? What about when you get older? Don’t you think you will get tired and burned out?”
I don’t think so. I reply, “I love my job. When you love your job, you don’t ever get tired.”
How naive I was.
Emergency medicine is tough, sometimes even painful. Deaths, we can’t help. Diagnoses of incurable diseases. Bad news. The pressure to be good, perfect, productive. Adding to that, many of us work in corrosive health systems: The result? Emergency Medicine can burn you to your core.
Being in love with Emergency Medicine is enough to protect us?
Emergency Medicine can burn you to your core.
Leaving the Comfort Zone
I am a curious soul. While I learned more about emergency medicine, I discovered another world with worldwide Emergency Physicians, who could understand my difficulties and help me learn remotely from them. I fell in love again with #FOAMed.
Hearing the experiences of my colleagues from all around the world inspired me to travel and meet those people. I wanted to learn with them and to compare how Emergency Medicine is in those places.
My newly found calling took me to Sydney in Australia, such a lovely country, which had beautiful and polite people, good public transportation, beautiful scenery, and even a public healthcare system too!
I was lucky enough to spend time in an excellent hospital in NSW. I witnessed them receiving a trauma patient and listened to them as they plan patient management. I was speechless. I felt a sudden sadness to the degree that I wanted to crawl back to my mother’s womb.
When I tell this story, people often react, “You don’t need fancy stuff to practice Emergency Medicine,” but it was not what I saw there. What was it? It wasn’t the video laryngoscopy. It wasn’t the infinite bougies and disposable LMAs. That’s true: The facilities in Australia were incredible and so much more were available than back home in Brazil. But it was still the people.
When the paramedic team arrived, the whole team discussed the patient plan. They were so courteous and respectful to each other, focused only on doing the best for the patient. They were excited about the case, energized, and happy for doing their best.
I’m not saying their life is easy. I’m not saying they don’t suffer moral injury. But I’m sure they don’t show ill-will to their peers and most importantly, to their patients. I want so badly to be able to do that kind of medicine, but the realization of this new health system made me feel envious and perhaps even hopeless. Their experience was so positively different from mine.
I spent the next day in my room, lying depressed in bed, staring at the ceiling, trying to figure out what to do now: “How I would love to have that experience in my hospital!”
I thought a lot about what happened there. Why did it hit me so hard? I knew that not all hospitals were the same in Australia as some hospitals had problems and struggles like in Brazil. I already knew that we had hospitals in Brazil better than mine. Why did I feel so hopeless then?
Now, looking back, I can understand better. I was pushing my comfort zone further than I ever did in my entire life. I was discovering a lot about myself and my capabilities. I was achieving success through FOAM. And so, I saw my limitations, I strumbled in a deep Impostor Syndrome and lost some excellent opportunities. I was in such a fragile mindstate that I felt like the system was unfair to me.
In my hospital, which is always overcrowded, I work with physicians that don’t have the mindset of Emergency Medicine. When a trauma patient arrives, it feels like a battle. Physicians challenge paramedics: “Why did you bring this patient here when we don’t have bed enough?” or “we don’t have enough surgeons!” or “why does nothing here work?”
All too frequently, the team ends up shouting at each other.
I tried hard to spread the ideas and visions I was learning. One time, I asked for an ultrasound machine, my boss laughed in my face: “Where do you think you are?” Everybody seemed so consumed by pessimism and fatigue that they lost all hope.