Changes in E.R. Medicine

One of my E.R. colleagues came up to me yesterday, leaned against the wall, and told me he’s retiring next year. 

“I’m sixty-seven years old; I’ve worked long enough.”

“What will you do?” I asked.

He shrugged, gazing out to the treatment area where a dozen patients waited his care.  “I don’t know.  I feel like I’m falling off a cliff.  How do you give up the only thing you’ve ever done, what you love more than anything in the world?”

It’s true I love being an emergency physician, often proclaiming “I’m saving lives and stamping out disease.”  Though the work isn’t physically taxing, this coming year I’ll turn sixty and I feel my age.  Working three or four consecutive twelve-hour shifts leaves me considerably more exhausted than when I started practicing thirty-five years ago.  Medicine has changed in those years; we used to typically treat five to six patients an hour, now we average about two to three.  Huge changes have occurred in diagnosis, treatment, and testing.  When I was in training, my medical school in the Houston Medical Center had one of the first operational CAT scans.  For the first two decades of my career, one couldn’t order a scan without getting permission from the head radiologist or neurologist.  Now it’s routine to order several CAT scans every shift.  The E.R. chart used to be a single 8 x 11 sheet, a few scribbled notes was all that was needed, now it’s a computer generated book.  When I began, cardiac care units didn’t exist, and ICUs were reserved for the incredibly ill or injured.

I’ve given up doing some procedures; applying casts, draining fluids in joints and bellies, and intra-cardiac injections (medication shot directly into the heart), though as an E.R. doctor I still do intubations, spinal taps, and joint relocations.  Diseases have changed.  Over the past dozen years staph abscesses have bloomed from rarities to everyday occurrences.  Meningitis in infants has almost disappeared.

I doubt I’ll still be working full time as an emergency physician in another eight years.  But I’ll still be a doctor; perhaps more missionary work, or volunteering at a clinic, or doing fill-ins at slower facilities.  Meanwhile, I do have another life.  I write.  I’ll write about medicine, and about life, and how getting older is just a transition, not a cliff.

I’m going to work on my non-fiction book in 2013, “Thirty-five years as an E.R. doctor.”  There’s so much to write, incredible changes, remarkable memories and changes in attitudes and care.  Until then, I’ll continue to work … to save lives and stamp out disease.  It’s what I do.