Portal de Periódicos da CAPES

Springtime in the Emergency Department

2012; Wiley; Volume: 19; Issue: 7 Linguagem: Inglês

10.1111/j.1553-2712.2012.01392.x

1553-2712

Esther K. Choo,

Emergency and Acute Care Studies

One April, I treated a 54-year-old man, whom I‘ll call Roger, for cardiac arrest. He had been pulseless for nearly 20 minutes by the time he arrived in the emergency department. To my astonishment, he recovered vital signs and was admitted to the cardiac care unit. A day later he was extubated, sitting up in his hospital bed, and eating lunch. Today, he enjoys camping on the Oregon coast with his wife and dog and visiting his grandchildren. As often happens in medicine, my version of what transpired differs dramatically from that of the patient and his wife. I know I performed routine ACLS—as anyone in my position would have done—and the patient was simply lucky to have been one of the very few individuals who respond successfully and make a full recovery. I also believe the 9-1-1 operator-guided CPR that the patient’s wife performed played a significant role in his survival and his subsequent near-perfect neurologic status. But the wife, who stood in the corner of the trauma bay as the team discussed whether it was time to “call it,” tells a different story. She says that as she watched us work on her husband’s lifeless body, she saw us take extraordinary measures to resuscitate him. To this day she insists that I did something special, that I tried a little harder or longer than other physicians would have, that I had some insight or experience or skill that led me to the specific actions needed to revive her husband. The patient himself will swear—although he was unconscious the entire time I treated him—that he instantly recognized me when I visited him in his hospital room days later and knew that I had saved his life. I don‘t let it go to my head. I‘ve been practicing emergency medicine long enough to realize that both the blame and the credit we receive as health care providers are often undeserved. Most of us have been on the receiving end of complaints—and even lawsuits—for cases in which the outcomes were clearly beyond our control, for cases in which, even after tortured rehashing of details, we feel certain we delivered the best care in our power. Returning to work after such an event, knowing that the best of your intellect, skill, and integrity may not protect you against patient perceptions or the whims of the medical–legal system, is one of the bleakest psychological challenges we face as physicians. Colleagues have described to me elaborate routines—pep-talks, meditation, or prayer—they have developed to combat the anxiety of walking into a shift while still coping with the emotional devastation from a recent case. Given the nature of our job, it is hardly surprising that we need these coping mechanisms or that even with them, we can come to feel bitter or burnt out. I try to keep cases like Roger’s in the back of my mind specifically for those tough days, when the stresses and impossible expectations threaten to undermine my enthusiasm for what we do. Once a year, on the same spring day, I get a boost in the form of a phone call: “Hi, Esther. You saved my life on this day and I’ll never forget it.” Obviously I don‘t deserve this. But perhaps it is okay, once in a while, to balance some unwarranted blame with some unwarranted credit.