Last night I worked the ED for a 10 hour cross cover shift from 12pm to 10pm. It wasn't crazy busy but I was never without 2 or 3 patients. The way the ED works is that there is an electronic board on the wall where all the docs and nurses hang out. As patients come in their names go on this board, along with a complaint (ie. difficulty breathing, abdominal pain, etc.). If you aren't busy with any patients or you can take an extra you simply go on the computer and type your name in as the doctor taking care of the patient. It sounds pretty simple, but whenever I'm in the ED, I live in a state of constant anxiety.
"What if this patient is too complex for me?", "What if I screw up?", "What if I have no idea what is wrong with this patient?", "What if...".
These are the type of questions that come to mind as I look at the patient complaint and place my name beside theirs. It may be an easy thing to type my name...but its painful powering through that anxiety every single time. What makes the ED different from something like Wards or really any other part of medicine is that people are coming to you with an emergent problem that no one has likely seen before. In Wards the patient comes in already having been stabilized in the ED or you get the patient in clinic and they are following up from a previous visit to the ED...in most other places in medicine you get patients that have already seen other doctors, other docs that have already braved that "fear of the unknown" and have put a face (diagnosis) to that problem for you. When you are in the ED and next to a patient's name you see "Hemophilia Disorder with Trauma and Bleeding", that could be anything...most likely it's nothing super severe or there would be tons of people rushing to that room...but you aren't thinking rationally when you see those words...you just don't know...and you fear what you don't know. That's how my entire night went anxiety alternating with relief. I'd see a name on the board, followed by a chief complaint. I'd go in the room and see the "scary" patient and realize it wasn't that bad. After awhile you start to realize it's not these patients or these situations you fear...it's the fear of what you can't see...it's your imagination scaring you not the patient.
Movie directors know this trick. The best directors in horror know that the secret to developing terrifying fear isn't putting something scary ON the screen...it's putting the audience in the mood for a scare and then leaving them with that infinitely expansive question, "What if?!?!?" and not answering it for as long as possible...that's how you build suspense...that's how you build anxiety...that's how you create true fear. That question is a powerful one, it's our imagination unbridled and uncontrolled, it can crush you into paralyzed inaction, it can drive you insane, and it can even kill you (or your patient) if you stay in it and with it long enough. For me it's a constant struggle to take another patient with a "scary" chief complaint, I wish I could say I'm never scared...but I'm scared almost every time I sign my name onto that board...but because I know where that fear really comes from, I can deal with it enough to get over it and help people. This isn't something that is exclusive to being in medicine...this kind of fear can be found all over. It's a lot like a black hole.
A black hole is so heavy that it's gravity wraps all forms of light around itself. The only way you can really detect one is indirectly. Looking at one distorts objects behind it, as if the stars bend to get out of it's way, and free floating nebula explode...seemingly for no reason. Sometimes the only way you can tell that type of fear is acting on you is by recognizing that you are trying to avoid something...or that you are "exploding" for no discernible reason and you have to ask yourself "why?" Because if you don't, that fear will suck you in and eat you alive., but if you can recognize that it really is there you at least have a chance at compensating for it and you might even learn something about yourself if you're lucky. That's a struggle we all deal with in fighting these little black holes that pop up in our lives, it can be found everywhere from walking into a garage without lighting, to putting your trust into a new relationship...you can even find it walking into see the patient in room 5 that's vomiting blood.
Newbie Doc
