The Chaos of the American ER

I’ve always thought of emergency medicine as one of those fascinating realms of medicine and hospital culture that are only attempted by the true “cowboys” of medicine. The men and women who crave the late hours, the adrenaline rush, and the truly frightening and fascinating cases. It is a realm of medicine that I would love to try for a month and probably burn out from within the course of a year.

Emergency is clearly the source of extraordinary fodder for medical drama shows. The “couple” who presented with a fork in the head and an injured groin was clearly adapted by Grey’s Anatomy. It is crazy and at times heartbreaking and leaves you with a group of stories that either reifies or makes you question your desire to go into medicine.

Some of the most impactful stories in Emergency were certainly those pertaining to the death of young children. It is one of those experiences and references that shakes one’s faith in healthcare and seems to defy the very point of medicine, to save the (once) young and healthy. The anguish felt by parents and as a result the human emotion perceived by doctors is one of those things that I imagine is and will be impossible to forget.

Another aspect of emergency room culture that becomes very clear while reading the book is that one will inevitably face bizarre and “unbelievable” patient encounters and as future doctors we are still expected to deliver healthcare in a judgment free way. The bizarre (and even gross) situations that patients get themselves into, whether it be self-castration or the insertion of foreign bodies into one’s body, will undoubtedly be jarring and even horrifying to deal with. Another apparent trend in emergency medicine is the increased use of hospitals as primary care facilities for the poor. Amidst the true emergencies and medical dilemmas that enter the emergency room each day, doctors and residents also face the time commitment of treating people for more common illnesses. While the number of cases treated in ERs are clearly trying, the stress felt by the doctors becomes apparent in books such as the House of God where one of the interns paid a patient to leave the ER.
The nature of ER medicine seems almost fantastical to me. In internal medicine or primary care one generally has a certain sense of normalcy or predictability that they can expect. Hopefully most patients will be scheduled and a doctor can plan accordingly. However, in EM the expectations are entirely different; a doctor must be able to respond to and treat a patient with little notice and often in the most trying of situations.