“Your dream is someone else’s nightmare….”


For those of us who work in an emergency medicine/ pre-hospital care we all have experience of saying or overhearing someone say: “I fancy seeing a big code red trauma or big sick patient today….”. We say it not to sound unsympathetic or uncaring but the sickest patients are the ones that drive and challenge us. They are the reasons why most of us have chosen this speciality. These types of patients can take us out of our comfort zone and make us learn new skills and be better clinicians. Remember  what we might be comfortable dealing with may not be the case for someone else though. As @embasic, in his excellent post on EM Mindset, eludes to EM docs are comfortable  managing  the undifferentiated patient: young, old, septic, trauma etc. The adrenaline rush you get when doing something and working in a cohesive team to save someones life is difficult to describe.

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We all want to be challenged. As an emergency physician, i’m still at the beginning of my career and have the urge to learn new skills and reflect on the difficult cases I have managed and eek out those 3 learning points to take forward to the next patient I see. ( there are plenty of reflective emodules knocking around on the internet, but i did this one recently which certainly helped me). I believe that those of us working in the ED  inherently do a lot of self reflecting as we aim to try and be better at the job we do. (I’m sure that’s also the case for other specialities!)

“When you’re gone would you rather have your gravestone say, ‘He never missed a meeting.’ Or one that said, ‘He was a great father.’” Steve Blank (entrepreneur)

Most of you reading the title would say that the “someone” having a nightmare is your patient. Performing a resuscitative thoracotomy may be something you’ve always wanted to do, but your patient may have a different viewpoint! I’m not really talking about the patient, that would be far too obvious! I want to talk about the impact our lives and our vocation has on our families. I hadn’t really thought about it until  recently when I had got a consultant post and my wife said “See, told you all those weekends and nights over the last 10 years would be worth it….”.

My wife likes hearing about my day and the sick patients I managed. What she doesn’t tell me is that because I was late off work, she had to cancel her drinks with friends, rush back and pick up our daughter from the child minder, get food shopping on the way back home (not easy with an active toddler!), make dinner, bath and put the little one to sleep, and hoover the flat. This is a recurring theme during my training and I’m sure others can relate to this situation. Cmdr Chris Hadfield said this about his job as an astronaut and the impact it had on his children:

“When your dad is an astronaut, the most interesting thing about you growing up doesn’t have anything to do with you and is out of your control. It trumps everything else people see when they look at you…”

We underestimate the impact our work has on our families. A friend of mine says she only really got to know her father properly when he retired from medicine. Perhaps he was doing extra shifts to pay for her schooling or university or holidays. She was 24.

It’s not just in medicine either. I was talking to some school friends recently who work in banking and city law firms about their lifestyle. They all work incredibly long hours and have all said they have missed out spending time with their loved ones because of deadlines at work. Have a think about how many child milestones, life events, family birthdays etc you have sacrificed so you can do your job.  Saying “thank you” to your wife/partner isn’t enough when they are the ones making the bigger sacrifice.

Sustainable work. The RCEM has produced several documents on this which are on their website. The STEP campaign and Sustainable Working  to name but two. Flexible training is an option that I think more people are taking up, certainly compared to when I first started in EM. Anecdotally flexible trainees have said their work life balance is much better compared to when they were full time (no surprises there i guess).  I’d be interested to know from those who have spouses/partners that work an “on call” rota and how this impacts on their family. Are there rota systems out there that can improve the work life balance? (for example self-rostering). How does your employer (Trust or ambulance service) ensure you have a sustainable working life? After all it’s in their interest to enable you to give many years of service to them as a skilled and experienced clinician. RCEM produced a stress and burnout document which downloads as a PDF. Just type in “RCEM stress and burnout” into your search engine.

“Sweat the small stuff”….

Anticipate the impact your work has on your families because you missed out on significant events. How are you going to compensate them? Prioritise family time like you would do a meeting or a clinical shift. Show them that you are not taking them for granted by planning how you are going to spend the time with them.  It may just be a sunday morning with breakfast in bed followed by a walk with the dog. Whatever it is, grandiose or small, make sure you have planned for it. I hope it was a short but useful read. I realise there’s no real educational pearls but hopefully it does give you a nudge to set aside some time to spend with the people that have really made sacrifices in order for you to  be where you are today…. KR N

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