Standing the Post

Mary Claire O’Brien, MD FAAEM

“Why are you still working?” my adult children ask me. “You need more hobbies.”

“Hobbies?” I say. “Hobbies are for normal people. I am still working because I am not a wimp! I am an emergency physician. It is my job to Stand the Post.” Why am I still Standing the Post, after 36 plus years? Some days I am not even sure myself. “Hey,” a colleague said. “What lights your fire? Why do you get out of bed in the morning?” “Taking care of patients,” I answered. “Helping patients and their families.”

This is a crazy time to be practicing emergency medicine! The whole thing is a cluster. Staff shortages, budget constraints, vaccine wars, opioid crisis, gun violence, racial inequity, climate change, inflation, health system mergers, new payment models, JCAHO, Covid—Covid!

Here is the thing: this is not my first rodeo. When I was a resident in the mid-1980s, we did not understand the illness we now call AIDS. An infectious agent called HTLVIII was killing people on the fringe. We heard it had something to do with eating bush meat in Africa—so why were people in Philadelphia dying of it? Patients who were intravenous drug users developed a terrible wasting illness, or severe hypoxic pneumonia caused by a “parasite,” or a horrible blotchy purple skin cancer.

All with no cure. They lay alone in the hallways, and died. We had no idea what was going on. As clinicians, we did not know if touching the patients with “HTLV-III” would make us sick. Transmissibility had not yet been defined. How did they get it? Would we get it? Would we give it to our spouses? Our children?

We did not know.

We Stood the Post.

SARS: “Have you travelled to Asia?” MERS: “Have you travelled to the Middle East?” Ebola: “Have you travelled to Africa?” Covid-19: “Have you been to the grocery store?!” “Are you mad at the patients?” asked a resident. “I’m mad.” “Of course I am mad,” I said. “I am mad because at this point in the pandemic, so much of it seems preventable. I am mad because the vaccines are not keeping health care workers safe. I’m mad because unvaccinated people show up sick as stink with Covid pneumonia and expect us to fix it.” Believe me, we clinicians are all worn out with this. We are mad at the patients. Here is the great irony: we are mad at each other! We are careful, compassionate emergency professionals who make the best decisions we can—under pressure, with incomplete information, with limited resources—every day, just doing the best we can. After two years of Covid chaos and severe staffing shortages, we are struggling to give one another grace—when someone forgets to check the labs, misses some-

“HERE IS THE THING: THIS IS NOT MY FIRST RODEO.”

thing on an X-ray, didn’t speak with the consultant yet, hasn’t wrangled a disposition in a timely fashion. Mental assessment: “You are leaving me an ED that is a mess. OMG, WHAT A MESS!”

Pre-Covid verbal reply: “No problem! Give me the keys, Friend. I know how to drive this bus.”

Responses of late: much less amiable. Because now—it feels like every day is a bad day! For almost four decades my prayer while walking from the parking lot to the ED has been: “Help me help the people.” These days it is: “Help me not lose my temper for 8 and a half freaking hours.”

Give me the grace to encourage those around me. Help me Stand the Post .