My shift started at 7 a.m. The overnight physician wishes me a good shift. We both know that’s mostly luck. I pick up my first patient before I’ve taken a sip of coffee.
My first few patients are what we affectionately call “bread and butter.” An ankle injury. A cough that’s lingered for two days. Back pain. A medication refill. Someone wants an MRI today because they’ve had headaches for three months. None of these complaints are unimportant to the person experiencing them, but each one requires the same careful evaluation, documentation, and explanation.
While I’m interviewing one patient, a technician silently hands me an EKG. I excuse myself. Normal. Back to the patient. Before I can ask my next question, another EKG appears. Then a nurse needs pain medication ordered. Then radiology is calling. Then the laboratory has a critical value. Then EMS is two minutes out. Then another EKG. I still haven’t finished evaluating my first patient.
By late morning, the waiting room has grown. Patients have waited for hours because every emergency department is operating beyond capacity. I understand their frustration. If my family member were waiting, I’d be frustrated too.
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But frustration often arrives with a target. “I’m paying your salary.” “This place is short-staffed.” “I’ve been waiting forever.” I apologize for delays I didn’t create and cannot fix. Then I walk into the next room smiling, because the next patient deserves my full attention, not the emotional residue from the last one.
Just before noon, my stomach growls and I think I might finally grab something to eat. Then the overhead speaker announces a cardiac arrest. Everything stops. For the next forty minutes, nothing else exists. Compressions. Airway. Epinephrine. Ultrasound. Rhythm checks. Hope. Then acceptance.
The patient is in his fifties. Despite every effort, we cannot bring him back. We stop. I hear myself say the words I’ve said hundreds of times before. “Time of death.”
His family arrives after we’ve already stopped. Moments earlier I was leading a resuscitation. Now I am sitting in a quiet room explaining that their husband, their father, their brother has died. There is no perfect way to deliver that news. There are only honest words and shared silence. I stay until the silence in the room tells me it’s time to leave.
I walk out of the room. I wash my hands. Someone asks for another blanket. I finally sit down to document my first note. Three sentences in, another EKG. When I return to the computer, I stare at the screen trying to remember where I left off. Then another interruption. I missed the nursing home’s return call. CT is still backed up. The lacerations are still waiting.
I realize I’m still hungry. Coffee is the only thing I’ve had all day. I also realize I haven’t gone to the bathroom. I keep seeing patients.
The afternoon becomes a blur. Falls, chest pain, urinary tract infections, headaches, consultants, repeat exams, documentation, phone calls. Every conversation must be documented. Every decision matters. The elderly woman from the nursing home still has no family answering the phone. Eventually I become her advocate, because there is no one else.
The shift is finally winding down. Then a child arrives. The imaging is wrong. Terribly wrong. The room suddenly feels much smaller. The words become impossibly heavy. A mass. An urgent transfer. The possibility of cancer hangs in the air before anyone is ready to say it out loud. The parents look at me for reassurance I cannot honestly give. I explain what we know. I explain what we don’t. I answer questions I wish they never had to ask.
My shift is over. Technically. I give sign-out to the next physician. I walk to my car. I’m dehydrated. Overstimulated. Emotionally exhausted. I never actually made it to the bathroom.
I sit in silence during the drive home. I don’t have the capacity for my audiobook or music. Cars line up outside stores along the way. People are picking up dry cleaning, grabbing dinner, enjoying the summer. The world kept moving while ours stopped, again and again, today.
I walk through my front door. My family deserves the best version of me. They deserve patience, attention, and presence. Instead, I’m trying to remember where I left pieces of myself over the last nine hours, in the family room after the cardiac arrest, with the frightened parents whose child may have cancer, with the lonely nursing home resident with no one to answer the phone, in the waiting room where anger and fear so often sound the same.
Tomorrow morning another physician will wish me a good shift. We’ll both know that’s mostly luck.
Christine DeSanno is an emergency physician.
