Feedback
FEEDBACK
With the first half of my first year in training out of the way, it seemed as if everything was under control.
At that point, I had just passed the MRCEM Part A – a truly remarkable achievement, given how hopeless I felt about studying after having been away from the world of academia for more than a year and that I now thought of myself as incapable of sitting down and studying. I had also started to diversify a bit when it came to medicine. I was attending more pre-hospital events, and I had signed up for a course to become a life support instructor.
Having taught English as a foreign language for four years, and then having assisted on so many PADI courses during my divemaster training, I gotta say the experience came in handy. Finally being able to formally teach something medical would not only be good fun, but also a huge asset to my career. Basically, I was doing really well.
Or at least that’s how I felt. I kept pestering my seniors for feedback. They had nothing but good remarks on my work thus far. They praised my clinical acumen, my efficiency and my enthusiasm for the job. And when it came to the mid-year review with the clinical supervisor assigned to each of us, it was more of the same.
He did point out that I should be less nice and butt in when it came to resus cases, though – as if that was my call to make. Try as I might, I’d most often end up covering the low priority patients or the paediatrics department. I could count the number of times I had been to resus on my hands – particularly if one hand and a half were to be chopped off.
The Weight of the Job
I, on the other hand, had a lot of feedback to impart on the department. As happy as I found myself working at the ED, it was still far from being the best work place. In fact, the list of complaints runs long. Maybe way too long.
First off was our salary. Don’t get me wrong. I’d do this job if they paid me ten cents an hour. Hell, I’d do it for free. I have done it for free. But when push comes to shove, I really feel we’re not properly remunerated for the things we do. I’m not gonna say I rely on social security to get by, but all things considered, I do believe we are severely underpaid. Just for context, as a BST in my first year of training – meaning after five years of medical school and two years of foundation programme – I was paid almost as much as I used to get while teaching English as a foreign language, a summer job that required a six-week TEFL course.
Second of all, our training programme is by far one of the most demanding. It’s not just that we have to show up for work. We also have to sit exams, maintain an online portfolio, complete audits and take part in a bunch of other extracurricular activities if we want to progress. We have to get to hospital earlier than we otherwise would have, leave later or come in on our off days to finish most of it. You’d think we’d at least be remunerated for those countless hours. But nope.
The Mental Toll
There’s also the nature of the job to consider. I mean, think about it. Every single day, we’re forced to endure all kinds of emotional trauma – from disease and death, which affects some more than others, to verbal and physical abuse from patients, relatives and colleagues alike.
No lecture in medical school could ever prepare you to deal with such things. How to tell someone the love of their life is dead. How to explain to a patient who is crippled with pain that there are twenty other patients before them. How to tell someone with a fractured leg that crutches are out of stock. And, more importantly, how to tell entitled pricks who think they’re the only ones with a problem to politely eff off. Believe it or not, we actually do want to help out.
We’re also constantly making life-versus-death decisions. If an accountant screws up, odds are – cause you never know – no one’s gonna lose a limb or a life. If I do, odds are, they might. And that’s only if I screw up. In medicine, nothing is ever certain, and there is never a guarantee that a certain treatment will work. Meaning anything can and probably will go wrong at some point – even if you do things as you should.
If that’s not enough pressure, keep in mind that we don’t get to see one patient at a time. We’re juggling multiple lives at one go. Multitasking has been shown to increase the risk of mistakes and is not efficient at all. That said, what other option is there when the system is so overrun? At any point in time, most doctors working in the ED are responsible for an average of two patients. That’s double the responsibility.
The Physical Toll
If stress and responsibility aren’t bad enough, there’s also the physical element too. We’re usually running around ragged non-stop for eight hours straight – twelve if it’s a night shift.
We might be able to escape the chaos for a few minutes to wolf down our lunch – always a pleasure to see patients glaring at us if we so much as dare to get a cup of coffee – and that’s something we have to fight for, given that there are no assigned breaks. In fact, I didn’t quite rejoice when they spent a crap ton of money on those new reclinable sofas they got in our pantry. As if we’d get to make good use of them. You know who does, though? Staff from different departments who sometimes come to our pantry to sleep on them.
That said, on quiet nights – which usually happen once every other month – we manage to get a one-hour break (two if we’re super lucky), which, wonder of wonders, seems to make all the difference in the world come dawn. After most night shifts, I’d often find myself having to force myself awake while driving back home – slapping myself silly or pouring water over my face. Others aren’t always so successful. You have no idea how many doctors crash and end up right back at the ED after such shifts. We often describe our idea of hell as having to start another shift at the end of a night shift – imagine having to go back with a broken bone or two.
Also, speaking of added risks, we are more often than not front-liners. I’m not saying that in the pretentious, glorified way we used to be portrayed during the pandemic. I’m saying that every patient who walks through the door with a potentially contagious disease – even just a minor cold – could infect the entire workforce. No wonder almost everyone I know who works in the ED is almost exclusively, perpetually sick. The irony is that, oftentimes, I’m actually sicker than most ESI 3 or 4 patients who come in with simple flu-like symptoms.
You’d probably reprimand me for going to work sick, but when you’ve been at it for months, there’s not much you can really do about it. And again, this is the norm for most people working there.
Showing Up
The bottom line? It’s a thankless job – that’s for certain. As decent and noble as emergency medicine might seem from the outside, it is still, in so many ways, thankless.
We don’t get rewarded by the people at the top who should be looking out for us. We go to work every day and face the worst conditions possible, making the best use of very limited resources that seem to get scarcer by the day, and face the backlash ourselves despite our best efforts. The patients we spend hours trying to help are often so alienated by their pain, their fear and the long waiting times that we don’t always get so much as a “thank you” in return. And why would we? It is our job, after all. Plus, free healthcare isn’t exactly free. Patients pay for our services through taxes – they deserve the best treatment we can give them.
It’s demotivating and heartbreaking, that’s for sure. But at least we have each other. We’re all stranded on the same sinking ship and, every day, we willingly jump back on board knowing we’re probably gonna drown together. At the end of the day, we’re there for each other, cause we all go through the same thing together. It might sound hyperbolic, but that’s the sentiment shared by most of us working there. Doing things right often goes unnoticed. Mistakes are remembered far louder than effort. Exhaustion is treated like part of the job.
And yet, despite all that, we still show up. Day after day. Shift after shift. Even when we know we could be doing something else with our lives. Even when we know we could be happier, healthier, freer. Cause one thing’s for sure: it might be the worst job ever, but it’s also the best damn job I could ever dream of.