Musings

A grey and cold spring day sets the B.O.N.E.R. doc's mind drifting into some dusty corners. I was recently chastised for my infliction of boorish behavior on the ER nursing staff. As the world's oldest ER doc, I have been witness and sometimes the victim of the rapid changes in the delivery of health care.

Back in the dark ages, doctors were demi-gods. We ran the hospitals. Nurses would take orders and say, yes Doctor. The death of a dear and treasured friend reminded me of the demise of this paradigm. When I arrived at my current hospital, I was residency trained and board certified in Emergency Medicine. This made me a rare bird. No other hospital in the area had a "real" emergency medicine specialist. I had been at a major teaching hospital prior to my debut at the Generic Hospital.

Three senior nurse supervisors gave me my first lesson in how the ER was changing. They welcomed me and offered me their friendship. Titles and last names were strictly followed. I was Dr X and they were Mrs. Y. There was no doubt who had the real power; it wasn't me. Forging ahead, I worked with many wonderful nurses. As I educated them in the latest trends in EM, they schooled me in the politics and policies of ER management.

Health care management continued to evolve. I never had a problem with maintaining my knowledge of the new equipment, medications and diseases that an ER doc faced. The relation between doctors and nurses and doctors and administrators was much more difficult for me to handle. My mentor and boss was and is my shining example of how a physician should adapt to this new partnership in health care.

Today I often find myself conflicted. I am still a good ER doc. Thirty years of experience has made me effective and efficient. Thirty years of the stress, sleep deprivation and ingrained behavior have made me a cranky and often difficult person to work with. Press-Ganey patient surveys and empowered nurses make me feel like time has passed me by.

Hospital management rightly recognizes that medicine is a customer oriented business. Patients, their families and hospital employees must be given reasons to choose Hospital Z vs Hospital W. A work environment that is supportive and cooperative is mandatory. The patients and their family expect excellent treatment along with a customer first approach.

What is a dinosaur to do? Adapt or move on. I took a course in workplace conflict and communication. My director and friend has the difficult job of trying to keep me from career suicide. Why continue? I love being an ER doc. I get to help people and occasionally save a life.
This past week, two patients reminded me of why I persevere.

An elderly woman arrived from the nursing home in respiratory distress. Her son and grandchildren were at the bedside. The patient had a Do Not Resuscitate directive. She was in end-stage congestive heart failure. Her lungs filled with edema, she struggled to breath. Her son and I talked about options. I offered to give her small doses of morphine. He and I agreed that the humane course was to give her the morphine understanding that it would hasten her inevitable death. She died a few hours later but was much less distressed during those hours.

On another recent night, I saw a friend come staggering into the ER. Pale, sweaty, and clutching his chest, the diagnosis was obvious. The intervention cardiac team was activated and my friend had a successful angioplasty. My friend looked at me and said "I knew you would be on". His confidence in me and his appreciation of my efforts are why I will continue to be the "world's oldest ER doc".