Cry

Hail,
Very brief note - an overdose is turning up in about twenty minutes to the ED and we have to be there. Another too-quiet day at ICU. Our lithium overdose man has been discharged, (after his thirtieth admission), our airways disease woman is sleeping peacefully and our "pink puffer" - a little old man who breathes through pursed lips and cannot walk across the room without resting, but who is listed as the principal caregiver for his wife - is asleep in a chair.

And Dr Fang is doubtless asleep, tormented by visions of other doctors who earn more and have bigger breasted nurses, and Dr Bill is devouring another pizza with the feckless enthusiasm and manic metabolism of youth. Which leaves me studying and several nurses re-reading the newspaper and talking about the lemon detox diet.

A few things have been happening. A mildly amusing anecdote that illustrates the difference between Emergency Medicine in the US and Emergency Medicine in the rest of the world. Our consultant was saying how when he was a junior medical officer, his boss (an ED doctor) invited an American doctor over for some teaching - someone from Chicago or Detroit or somewhere. This was back in the seventies, by the way. The American doctor talked a bit about EDs (or ERs) in the US, and then it was question time.

First question from one of the British doctors: "We don't have as many guns over here as you do - so how many shootings would you see in the ED in a year?"

US doctor: "Oh, about ten, fifteen in a year"

UK doctor: "Really? I would have thought you'd treat more gunshot wounds than that..."

US doctor: "So sorry, misunderstood you. We treat about five, ten gunshot wounds a night. But every year we see about ten, fifteen people who are shot while they are waiting in the ED waiting room"

Another world. I won't bore anyone with my deeply predictable views on gun ownership, but I vaguely - and I mean vaguely - recall reading that most people who own guns never use them. Following "not used at all" the next most likely use to which a gun is likely to be put is to commit suicide. Following that the next most likely use is homicide (I can't remember if that is only completed or if it includes attempted as well), and after that comes protecting yourself against the home invasion (by some guy who is also almost certainly carrying a gun, and thus further spoiling the averages for the law abiding folk).

But anyway - not something there's any point arguing about. My sympathies to anyone who's had a loss.

Further news: I am beginning to suspect I suck at my job. Not all of it, not every last bit, but important parts. And some of it is doubtless due to lack of practice - it's been a long time since I've had to think about all the causes of long QT syndrome, for example. But some of it, I fear, may be more serious than that.

Without wishing to grab my hanky and rush off, I have realised that there are parts of my job that I am not good at, that I have never been good at, and that I will, in all probability, never really be good at. There are skills are not going to come to me no matter how hard I work, there are areas of emergency in which I will never reach an adequate standard.

See, part of ED is not only knowledge base, it is cognitive style, ways of seeing that affect your thinking and thus your ways of doing. This will all sound waffly, but the way I see things - and thus think things and do things - is Dionysian rather than Apollonian, synthetic rather than analytic, mediaeval rather than enlightenment. Perceiving rather than judging, in that Myers Briggs thing - and in ED you need someone who can make a quick judgement.

This means when a patient comes in the things that stick out to me are impressions rather than facts, inappropriate emotional flatness, say, rather than elevated serum potassium. And I'm not saying this to say "Oh, look how mysterious and ethereal I am, not like these common clods of clay, my fellow registrars", because I envy my fellow registrars their ability to hear ten different serum electrolyte levels and spit them back at the consultant five minutes later. I wish I could do that, deliver those quanta of objective information, but the thing is, I find it really, really difficult.

And it's getting easier, but it's bloody hard work. I still waffle when I should be clear, meander when I should cut to the chase. Because of this - and a number of other proofs - I remain convinced I am not particularly smart and not particularly good at medicine. Speaking with patients, basic concepts in medicine, that kind of stuff I can do, but this high velocity data flow stuff, this crystalline clarity, this unambiguous certainty... not easily.

And yet, for some very difficult to articulate reason, I have chosen a training programme that has as its end point the assumption of a leadership role in exactly the kind of situation at which I suck.

Anyway. Two years ago I would have poured my heart out about this. Instead I am going to go down to the ED, and then go home and sleep... so I can get up early and hopefully read up on some of this stuff before I go in.

Thanks for listening,
John