Articles and Case Studies

A day in the life of an ED clinician

07 Dec 2023

Dr Michelle Johnston

by Dr Michelle Johnston

Reflection of an ED clinician (Dr Michelle Johnston supplied)

I’ve been doing this job for a while now, and I’d like to share with you some of the wisdom I’ve attained over the years. I believe I may have something to offer – the wealth from my experience. We are now all schooled in wellness and life-balance, and I have taken this gentle, lapping mindfulness to heart.

Once in a while, we don’t have to be epic. We can be a plain worker bee – low ranking, mission brown, a serf. We are permitted to hitch up our strides like peasants, and get on with the business of hoeing through the garden of the unwell.

Such freedom, you say. None of the high-level responsibility of being in charge of the department. No duty phone. No behaving like a desperado when asked to go to a flow meeting. Just good, honest toil.

I usually start rostered days by rising at 5.00am, meditating for 20 minutes, then fixing an oaty berry bowl of deliciousness, after which I write down a list of things that I craft into an acrostic poem. Things about gratitude, goals for the day, things I can teach my juniors, things, other things, aphorisms. And I absolutely would do these things, except that I don’t. Ever.

Most days I drive in, late and flustered, already slightly rageful at the insolence of traffic cones; un-breakfasted; in mismatched scrubs; and the most mindful thing I do is try and compose a humorous but slightly pathetic tweet whilst stuck at traffic lights… so that by the time I get into the heaving department, this place bursting at the seams with Very Unhappy People, I will have two, maybe three replies by kind people saying, “There, there, it will all be alright.” I hope to God they mean it.

I stride in, fortified. I have four likes and a retweet. A record. Somebody cares for me.

Faced with a handover, and a to-do list that would make a self-help author blanch (shock this person, drain the CSF from another, placate this patient, find out what’s wrong with this one – please – and maybe this one too), I focus on the main apothegm that will get me through the day. Smile, be kind, and work on being only a minor train wreck. It mostly works.

I fire up the plough. I dive into the innards of people. On the whole, my job consists of figuring out what’s not wrong with people. I have become an expert in recognising the dark matter of the emergency pathology universe – once I know ‘what is not’, I can work out where to deal with ‘what is’. This should be simple, except my day is now less ploughing, more running in a blindfolded steeplechase… and not on horses, but cows with a particularly dementing strain of bovine spongiform encephalitis. There are barriers, pitfalls, lava pits and sinkholes. It is not pretty.

I am very keen to teach the interns something. Five-minute teaching, bedside pearls, teaching on the run… that sort of thing. But thus far, the potential clinical encounters have been a large-bodied nudist who is currently in dispute with God, several patients with hazy chest pain, a scandal involving a nursing home where one resident swallowed another one’s tablets, and an extremely briefly run cardiac arrest.

I offer nothing. When I do haul an intern aside, sternly demanding this be a teachable moment, he presents his latest patient to me. I go in to see the patient. This is not the same patient he presented. Different story, different examination features, perhaps even different gender. I kindly confront him about this. He assures me it is the same patient. We sigh.

I, in the meantime, have a patient load of my own. Decisions, decisions. Much of my time is spent trying to work out which specialty team to speak to. I see more patients. I listen to the shadows and the echoes of the stories in these brushes with humanity. I pull my notebook from my scrubs pocket and jot things down. After all, I like to write, and these details are the lifeblood of novels. Unfortunately, when I take my notebook out on wash day, I realise I cannot read a single word of what I’ve written. Not one.

I also have, on rotation, a set of books that I keep in the other pocket. Virginia Woolf, Keats, other small anthologies of poems. Like my extreme commitment to mindfulness, I read and reflect on these often – which, actually, is also an Instagram-grade falsehood. Mostly, they simply offer succour by being close to me throughout the long day, even if I never read them. I am a poor excuse for a novelist, I realise, and go back to focusing on being a doctor.

For an hour, I look after the unbuckled body of a boy in a motorbike crash. I think he might die, and for the duration I have a nameless ache in my entrails, part nausea, part fear, that despite all I know and all I can do, it might not be enough. I might not be enough. He hangs on long enough to get to ICU. A minor success. Cases like this, however, feed on your adrenaline, leaving you tired and depleted. I wish, for the millionth time, that we had little rest pods – white, comfortable, softly lit refuges – where nobody could reach you for 20 minutes. We don’t. Instead, I buy another coffee.

I return to it. The training registrars with whom I work are quite brilliant. I learn bucketloads from them, and I am sustained by their commitment and energy. We have this quaint setup where they assure me they are learning from me, and are grateful for the teaching, on and off floor. They say this sincerely, and we all smile.

Emergency medicine evolves faster than Monsanto canola. It’s hard to keep up with all the latest and greatest. But, funnily enough, it’s the doing of the basics well that seems to be the most effective tool for the best patient outcomes. Perhaps there’s something to be said for us plodders, turning up again and again, year after year, just trying to do the best for the single patient in front of us.

No system or institution is perfect. Ours certainly isn’t. But I honestly believe we do a very good job for most of the people who have the misfortune to hurtle through our doors on their bad days. Their days are our days. We’re in it together. We, the proletariat of medicine. I clock off, joining the queue shuffling out the doors in our overalls.

 


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Communication with Colleagues, Communication with Patients, Doctors Health and Wellbeing, Employment Essentials, Emergency Medicine
 

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