By Dr. Farya Rehman
Welcome to Emergency Medicine
“This is it. I’m an Emergency Medicine resident.”
That’s what crossed my mind while driving to my first shift. I was assigned to the resuscitation area at a trauma centre for the evening along with a senior resident and an attending. I remember arriving with a smile on my face feeling a little nervous and excited. I was determined to do this right. I won’t lie, my hands were a little shaky. I still don’t know if it was nervousness, the double shot espresso I drank on the way to ensure I would be awake or the Formula 1 driving I did to arrive on time.
I looked for the senior resident, found my station and got to work, treating different patients from kidney stones to back pain, reporting to my seniors and asking questions when I was unsure. I remember thinking “Okay this isn’t so bad. I got this”.
Famous. Last. Words.
With absolutely no warning, 3 hours into my shift, my attending started giving orders, nurses started grabbing things, everyone was gloving up and walking quickly to the ambulance bay. I remember looking back and forth unsure if I should follow or what on earth was happening. What had I missed? I had only looked at my phone for a second. He was pushed in on a gurney wearing a torn blood-stained shirt. 28 years old, delivery driver, MVC, a hit and run the paramedics said. GCS was low, my senior resident took over the airway, successfully intubating the patient. Clothing was being cut away with trauma shears. An ultrasound machine was rolled to the bedside. Another doctor was attempting to put in a central line. Nurses withdrew blood for tests and someone had called for massive transfusion.
I joined the team unsure what I could do to help trying to not get in anyone’s way. I remember feeling like I was on the set of Grey’s Anatomy. Looking in from the outside. Everyone’s focus was on the young delivery driver. I remember thinking this was absolute chaos. Madness. Looking back now, I think to myself “No. It was organized chaos. It was Emergency Medicine”.
He received blood, chest tubes and even the trauma team had arrived. We worked for hours, trying everything possible. He wasn’t going to make it. His younger brother, the only family member in the country, arrived asking about him. I realized this is how I could help. I was the only one who spoke the family’s language. My role was to break the bad news. I remember practicing breaking bad news on simulated patients in medical school. I had never done it for a real patient, but I reminded myself of the steps. I told myself to remember that this was not my loss, this was not my pain. I needed to focus on the facts and not make this personal.
All was forgotten when I saw this young man’s tear streaked face pleading to save his brother’s life. He repeatedly offered to donate blood, a common practice in low income hospitals from his home country. Somehow that made this more painful. I counselled him and promised to update him with more news about his brother. I closed the door behind me, took a deep breath, wiped the unshed tears in my eyes, determined no one would see them. With a false smile, I went back to work. I had patients to see.
In the back of my mind, I knew I needed to process what I had witnessed. My plan was to take a break once the flow died down. However, even the best laid plans don’t work out. The moment I stepped outside fully determined to sit down in a hidden corner and reflect, I was surrounded by friends of the patient with more offers of blood donations, inquiring if there was any hope, and if there was anything to be done. I once again counselled and realized I needed to go back and see more patients. My break never came.
Afterwards, in the hospital parking lot, I finally had my break. I had never felt so confused at my own tears. I did not want to share how I felt with anyone because I didn’t want to appear weak. I felt guilty for crying. These were not my tears to shed. This was not my loss. I felt it was not very “Emergency Medicine” of me to cry. I was ashamed. I should be stronger. As Emergency Medicine physicians we thrive on hectic environments, we devour interesting cases and sometimes we are all that stands between recovery and death for patients. This is what we do. I wondered if maybe I wasn’t built for this. Filled with self-doubt, I drove home.
That was my first shift.
One of the most important lessons I learned from this experience is accepting the unacceptable. We volunteer to be a part of someone’s worst day, every day, every shift. This is what we have chosen. It is not possible to save every life that we see. The lives that I care for may haunt me on my way home, but I remind myself that I am human, I am allowed to feel and it doesn’t make me less of an Emergency Medicine physician.
My advice to other residents, especially First year residents, is work hard to be the best physician you can be. Read. Listen. Witness. Do everything you can to build your knowledge. When things go bad and they will — you’re the person people will turn to. You are trained and capable of stepping up and handling it, whatever ‘it’ is. It might be breaking bad news for the first time as it was in my case. You can’t always prepare for everything. But you have to be resilient. Brush yourself off after you’ve fallen and remember to pick up the pieces later.
Residency is a journey, it is what you’ve signed up to do. Now go do it!
About Author:
Dr. Farya Rehman
PGY-II Zayed Military Hospital Emergency Medicine program.
A little bit about myself, I was born and raised in the concrete jungle of New York. I moved here at the start of high school and completed my medical degree from Dubai Medical College. I am a Point of care Ultrasound enthusiast, interested in Critical care and a firm believer in promoting wellness. On the side, I love to bake and pretend I am a food critic.
One Response
Love you Mere jaan
I m so proud of you
Allah sawat give you more success and happy life with Majid
ALLAH always bless you