It’s not something you do…It’s something you are.

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I will be having turkey sandwich at work. As will many of my friends and colleagues around the world.

It throws into sharp relief an uncomfortable fact… Myself and many of my colleagues have spent more holidays with our coworkers than our families. Some would argue that because of the nature of our work, we are in fact family and not coworkers.

Today I am sitting in Starbucks (nowhere left to sit at Costa) listening to people around me. I don’t think I can identify with them. Sure we can talk about the weather or the tube. I could probably even have an intelligent debate with the law students doing a case review sitting next to me. But on most days, I am lucky if my current co-workers can even identify with me.

I started doing what I do young. I remember my first time putting on turnout gear. The first time I had ever held a rescue tool in my hand. The first emergency call I ever went on. The names and faces are as clear to me today as ever. I was not even old enough to drive and I was a veteran of doing CPR on actual people as part of the group called to help.

Since that day I have seen a lot. I can remember most of it if something reminds me of a particular call or case. It doesn’t haunt me as it does some of my colleagues. I don’t know why. Neonates, children, teenagers, adults, husbands, wives, parents, children, geriatrics, and grandparents; they ask for help and I simply try my best. Some days I win big and their problem becomes simply part of their story. Other days I am not so fortunate, and it becomes the end of their story (or simply part of somebody else’s).

At work, I was listening to one of my coworkers talk about the reasons she did not want to work in the intensive care unit. They mostly revolved around the amount of death and stress caused by seriously ill patients. She was quite happy with her low maintenance ward job. (A job I hate with passion unmatched, that was falsely sold to me under the guise of a trauma department). In fact, I would describe it more like half-assed medical care while baby-sitting patients who should be entirely under the care of other specialties. In real critical care we must be crazy. We go to work everyday with enthusiasm. We look forward to it.

Were I am now,we essentially do nothing for these people. It doesn’t even remotely look expert to me. I have to call for neurosurgical advice and consult on simple closed head injuries with insignificant radiological and no clinical findings. I spend hours on the phone trying to call ortho teams urging them to see their fracture patients sooner or more often, despite my knowing they have a “to do” list based on patient acuity. I can’t prescribe an antibiotic in or outside of the guidelines without calling for a microbiology consult, 99% of which end with the microbiologist reading the guideline to me after I read it on my computer screen moments before calling. This non-sense is continued with countless patients and countless afflictions. It is a great con.

I am told this is because we work in an academic center where the patients can receive top care from other specialists. But if we cannot provide care to our trauma patients at a top expert level, what exactly is anyone paying us for? I don’t even have a CPAP machine to keep people out of intensive care with. “Patients who need CPAP are too sick for our ward.”

Now I have lectured at nauseum that even non-acute patients deserve care, and I stand by that. My problem is I am not providing any care. Of any kind.

So what has this frustration have to do with my reflection on lonely holidays at work?

It essentially removes the 3 best coping mechanisms I have for dealing with the mental/emotional trauma of life. 1. A situation where I must devote all of my considerable faculties focus on. 2. An environment of like-minded and similarly experienced people who understand each other. 3. A familiar environment I am successful in.

The Japanese have a word. “mushin” it basically means “calmness of mind” or sometimes called a state of zen. That is how I feel in an emergency. It is calming. The whole world slows down and focuses. I feel my heart rate go down. My stress decreases, my many thoughts becoming purposeful, measured action.

A study by the US military a few years ago compared the stress response of “normal” soldiers compared to that of “special forces” when told they were going into combat. The normal soldiers stress response went up. The special forces guys stress went down. I like that study. Not because it makes me feel like a special forces operative, but because it actually explains what I go through when trying to help a critical patient. If it happens to others, I am not the lone weirdo.

Anyone who calls or thinks I am an adrenaline junky just doesn’t understand. It is not a high. It is peace.

The other day at, we were at “group lunch”. Every doctor from the department, sitting, eating, telling jokes, making fun of each other… My ability to silence a room is legendary. I was subsequently told “I often wonder what goes through your head, and now I am afraid I have found out.”

My coworkers in “trauma” do not understand how I see the world. My boss asked me if I liked being a fireman and paramedic so much why did I stop that to become a doctor?

My reply was a question to him… “What makes you think I have ever stopped?” Silence…

I am just a step in my progression. I didn’t “start a new career.” My prior experience and education is directly and constantly applicable to my current career. It is not like I stopped being a lawyer to become a doctor. It is not a reset.

This goes back to my reflection on coping mechanisms and camaraderie. These people in the “trauma” department have no idea. They are not a part of my world. They do not understand. They are 9-5ers in disguise presenting as part of an emergency world. Trauma in my world is holidays, nights, and weekends. Just like the fire department, the emergency medical service, or the emergency department, acute surgery and intensive care is the answer to a desperate call for help when it arrives. The knowledge, skills, and experience is the same.

Tonight, I am “on call” to answer the call for help for surgery all over the hospital. I will spend 90% of my night in A&E. 5% in a resuscitation bay, and the other 5% on miscellaneous medicine and admin.

Tonight I am not spending Thanksgiving working for the trauma department. I am spending Thanksgiving working for the general surgery department. (Who in our facility is actually responsible for trauma “after hours” aka. when it actually happens.) MY general surgery colleagues treat me really well. Many of them understand the value of an “emergency provider” or having a “fireman” to put out “fires” as they present in the form of hospital patient care. They may not “understand me” as some of my comrades in arms around the world, but they appreciate what I bring. That makes a difference.

I used to answer the question “what is the worst thing I have ever seen” with the response: “the inhumane way people treat other people.”

But I have a new answer. The worst thing I ever seen is people pretending to be expert and not helping at all people that look to them for help. It seems sacrilegious.

I do not buy the excuse of “other services provide more expert help which is better for the patient” or “we are an umbrella service making sure others take care of our patients.” We add nothing. We have no value.

Sorry for the seemingly disconcerted rant on my frustrations and feelings. But if you need the dots connected, I am frustrated at work which removes my coping mechanisms for dealing with the stress of my life and I desperately need them back.

But tonight. I will be at peace. A holiday night, working in an emergency capacity. With people who understand it. Whether you are part of my world or another, I wish you a peaceful thanksgiving as well. Have some turkey.

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