Emergency Department
By Will Lieber, 19, Illinois
Starting in April, I had the opportunity to work as an ER tech in a rural Midwestern hospital. I earned my EMT-B certification in my senior year of high school, and I was excited to finally put it to use. For the first time, I assumed a role directly involved in patient care. After 5 months, this job has deeply influenced my views of medicine and what it means to work, providing countless incredible experiences I will never forget. Here are 5 things I learned as a 19-year-old working in an emergency department:
1. The emergency department is a team sport
In an S-T elevated myocardial infarction, otherwise known as a STEMI, time is of the essence. A STEMI is a very serious heart attack incurred by the blockage of one of the heart’s major arteries. As a result, it requires urgent and immediate care.
When I witnessed my first STEMI, I stood in the center of the room, amazed by the swarm of nurses, doctors, and other techs who each dutifully shouldered a unique and specific task. Every individual knew their role, but they also knew their coworkers’ roles well enough to assist or avoid obstructing them. Our goal is to get a STEMI up to the cardiologist in under 40 minutes. Sure enough, within about 30 minutes, our team rushed the patient on the stretcher into the elevator. The mission was complete.
What is so remarkable about a STEMI is that, on their own, none of those individuals in the room could have accomplished what the team did together. In a very short amount of time, what used to be a death sentence for the patient becomes a weekend visit to the hospital. Because STEMIs have such a fixed time limit, the teamwork required to run an emergency department becomes very apparent. In reality, this happens for almost all the roughly 120 patients our department sees in a day, though over a less condensed time frame. Each person accomplishes a well-defined job role. If one person fails, the team suffers.
Here is a simple example. When patients come in through the walk-in clinic, they see the triage nurse, and then a tech takes them to their room. Once they get to the room, techs are supposed to help the patient change into a hospital gown. Sometimes, this does not get done. In those cases, the nurse or doctor has to spend 5-10 minutes doing that necessary job, and this sets every other patient’s visit back that amount of time. If this occurs 5-6 times, a feasible amount when seeing over 100 patients a day, the entire schedule shifts back about an hour. Despite seeming like a simple and harmless mistake, forgetting to gown a patient has legitimate consequences.
Especially when the department is overly busy, and I have a lot on my plate, it’s easy to get focused only on how busy I feel. Sometimes it is tempting to cut corners if I am swamped or tired. This temptation, however, only results in a burden for my coworkers, and that burden eventually falls to the patient. As in baseball or soccer, every player is necessary to keep the machine running. Even though stocking gloves is less glamorous than administering a lifesaving drug, every task, and every individual, has a hand in improving the lives of people in our community.
2. Hard work is a choice
In this particular community, many patients are blue-collar workers. Most work on farms or in factories, and they usually did not attend college. I enjoy talking to them about their professions, especially because the farmers remind me of home (my family also farms). Farming is a simple equation. You plant crops in the spring, and you harvest them in the fall. You will never reap more crops than you sow, and your profits are a direct reflection of your efforts. Chance typically only influences your yield negatively. A year of effort could be suddenly destroyed by bad weather, but plants never spontaneously multiply to increase your yield. This reflects laws of entropy, and also laws of work. If you want to improve your farming skill or attain high achievement, you have to tend to your crops. Without your attention, your plants will never realize their full potential. This means doing your best when no one is watching, and never losing your appetite for improvement. You will only get out what you put in, and to maximize your yield at the end of the year, you have to make the seemingly insignificant, yet difficult choice, to be your best every day. This job has given me the realization that self-improvement is a series of small choices to be better. Towards the end of my shift, I often feel exhausted and uninterested in doing the extra stocking for the coming day. I remind myself that if I cut corners, my team, my patients, and my character suffer because I did not do my best. This presents a choice: to let my plants wither and veer further from their potential, or tend to them, and ensure they are the best they can be. Working hard is a choice.
3. Education is a blessing
Since my job does not require a college degree, only a CNA or EMT license, most of my coworkers did not go to college. Some of them are college-age, such as myself, but many are older and have families. They will likely work as techs for the rest of their lives.
I enjoy this job, but the labor is hard on your body. All shifts are twelve hours, and each individual is expected to work at least three shifts a week, though many work four or even five for the extra money. I work with the night crew, so there is the additional stress of being on a completely different rhythm than the rest of your family. It is hard to be present in your time off if you are exhausted or near falling asleep. Most meals on the job are not very healthy, and usually, energy drinks or other stimulants are consumed en masse to stay awake. We are allowed one thirty-minute break, and though no one ever complains, they know there are easier jobs out there, yet it is one of the best options they have. Each day is a strong reminder of what a tremendous blessing it is to be able to pursue a degree. I think about all of the hours of backbreaking work my parents and my grandparents put in to give me the freedom to receive a college education. My education is the culmination of their efforts and college is not a place to squander that. It is the opportunity to continue giving the blessing of education to my kids and their kids. Because education provides the freedom to choose.
4. Achieving balance in time off is as important as duties on the job
Most people experience the issue of blurred professional and personal boundaries when working full time. With the additional graveyard shift work, I was no exception. As soon as I started, it felt like my normal hobbies, such as working out, playing tuba, and reading/journaling crumbled away. I lost a lot of my self-implemented support that kept me emotionally, physically, and mentally stable. Subsequently, I felt tired, I lost weight, and it became hard to make use of my days off because all I wanted to do was lay in bed. I often felt like a fraction of myself, which made for some dreary days over the summer.
Eventually, some of these issues resolved themselves as I figured out tricks to navigating nightlife. I learned to only sleep a few hours after getting off my last shift so that I could fall asleep around 10:00 PM and wake up around a normal time. Perhaps more importantly, I learned to focus on what made me feel better on my days off. Sure, I could probably have laid in bed on my phone all day, but then I ended up feeling like I wasted my precious summer. I knew I had to get up, move, read, play tuba, and do things with my friends because I would ultimately feel better as a result. I have always been pretty good at managing my own time, so having to be so intentional about planning my day was a new experience.
Humans are beasts of burden, and it is so important to find what burden fits you. To some degree, we are intended to work, and it’s important to seek out jobs you’re passionate about. Working hard builds character and leads to great opportunities. It also allows us to pay the bills. Work, however, cannot continue indefinitely. It is meant to occur in tandem with rest, and it requires supplementation with activities you enjoy doing and people you love being around. Achieving balance often feels impossible, but it is the key to avoiding burnout. Without work, we become purposeless. With too much work, we become husks. I am grateful to have had this experience in my formative years because it has shown me how integral work-life balance is to have a fulfilling lifestyle in my personal and professional endeavors.
5. Be like the spine
Most people think ERs are constantly inundated with traumas, critical care patients, and high-pressure life-or-death scenarios. This is partly a result of the romanticization of emergency medicine by the media, but at the same time, these cases do exist, though at a lower frequency than most people think. Regardless, I knew that on the job I would encounter some true emergencies, and I knew I might see a patient die. Eventually, it did happen, and I felt all of the feelings I expected to feel. I was able to talk about it in a supportive environment with people who understood the nature of the medical field. However, looking back on this experience, I was surprised by the coarseness of the nurses who also were involved with the patient. They quickly brushed past his death and even made some crude jokes before moving on as if nothing had happened. I knew that their bluntness was a defense mechanism implemented unconsciously to protect themselves from the emotional trauma of dealing with heavy events at work; however, I strongly felt that their behavior was wrong. Yes, seeing patients you have cared for pass away is hard, but that does not warrant behaving like you never cared at all. You can maintain the emotional tenderness of your younger self while also acknowledging that death is a natural process and that you are playing an important role in patients’ journeys.
When I first started, I knew I was seeing everything for the first time, and I felt an almost sacred sense of responsibility for all of the lives I stepped into, albeit only for a moment. I knew one day I might not see things with the same innocence I once did. Despite this, I resolved to never forget the sentiments of my younger self or the motivation behind why I started.
Oscillating between emotional vulnerability and resilience is exhausting. I cared so much for the people I was meeting, but it was eating me up at the same time. I needed to strike a balance. I approached two of my pastors, one of whom had been a flight paramedic for 14 years. Both of them I trust and respect deeply. Their recommendation was to become like the spine. I needed to be strong, rigid, and unflinching in the face of tragedy, like the spinal column. As long as there was a job to do, I could not let my emotions interfere with my duty. At the same time, I needed to be sensitive, feeling, and open to input, like the spinal cord. The spinal column by itself is impassive and lifeless. The spinal cord is vulnerable and unprotected. Together they form an intricate organism capable of navigating both the tender and coarse aspects of life.
This piece was solely inspired by my job as a tech in the emergency department. Having a full-time job, working night shifts, and working in such an intense environment were all new experiences for me, and writing about them is a critical part of processing and recording my own self-reflection.
