What Doctors Do: Oversee an Emergency Room

David Bracken never knows what he’ll face on his shift in the St. Elizabeth Medical Center ER.

Illustration by Headcase Design

Emergency medicine kind of blends everything together. It lets you do all different kinds of procedures and lets you see all aspects of medicine. I started working part-time in 1993 and full-time in 1997. Over the years, emergency room practice has changed. With emerging technology in heart attack care, stroke care, we’re expected to do more to patients in a short amount of time.
Tonight I’m working 4 to midnight. The busiest time is from about noon to one o’clock in the morning. We have such a large volume of people using us for primary care, and they come when it’s convenient, which is usually mid-day to evening. An ordinary day in the emergency department? I have no idea what’s out there waiting for me. It could be a slow day or you could have a bus accident on I-275 five minutes from now. I have no idea.

Probably the hardest day I ever had was about a year and a half ago. I was working down in Williamstown, where we have two nurses and a tech and myself. There’s no other physician in the hospital. A car pulled into the ambulance bay and a girl got out who was obviously pregnant. She was having labor pains. It turns out she was only seven months. She’d had little prenatal care, but she knew that she had twins, and she knew that one of them was breech. Ideally you would rapidly transfer her to a hospital that had perinatal services. But as I checked her, her membranes ruptured and she started delivering. For about three hours it was just me, two nurses, the mother, and two infants. The first infant took forever to deliver and I thought he was going to come out dead. But he survived. They were at Children’s for a number of weeks, but they both survived. That was a difficult day.

In 15 years, nothing has made me reconsider my choice. But there’s more and more pressure put on the system. It seems to take more time to document and do the paperwork than it does to talk to the patient. And that puts a lot more stress on us.
The hardest part of my job is diagnosing what is going on, not necessarily treating it. The challenge for us is that everybody we see is a new patient to us. If you’re an office-based physician, a lot of what you do is routine. Nothing is routine for us. It may be simple, but it’s not routine.

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