In the demanding environment of the emergency department (ED), healthcare professionals are faced with a unique set of challenges. We must deftly transition from critical tasks, such as coding a patient and conveying their death to their grieving families, to promptly attending to less urgent concerns. 

This requires a great deal of adaptability and resilience. Physicians must compartmentalize their emotions and treat each new patient with the same level of professionalism and care. 

A patient presents to the ED

In the midst of one of my critical care shifts as a senior resident, I entered the trauma bay to find the room filled with doctors, nurses, and patient care technicians. Their expressions quickly revealed the gravity of the situation: Before us sat a 39-year-old Spanish-speaking female with a medical history of asthma and a clotting disorder, for which she was on apixaban. She was 2 months postpartum and presented to the ED with chest pain and syncope. 

As the patient was in distress, her husband offered insight into her condition. Two days prior, the patient was seen at a different hospital for similar symptoms. Despite an extensive workup, including a computed tomography angiography of her chest that showed no evidence of a central pulmonary embolism, she was discharged when her symptoms had subsided. 

The situation turns dire

During our exam, it became evident that the patient’s condition had deteriorated significantly. She displayed signs of shock with a cool, clammy, and pale appearance. 

We immediately obtained an electrocardiogram, which showed a lateral ST-elevation myocardial infarction. The room became frenzied, as we rushed to place the patient on the cardiac pads and perform a bedside echocardiogram.

Amidst the chaos, her anguished cries for help and her palpable expressions of pain echoed throughout the room.

Her situation became more dire, as she began only intermittently responding to verbal stimuli and had a witnessed syncopal event. In a grim turn of events, her blood pressure plummeted and she lost pulses. Swiftly, advanced cardiac life support was initiated, and she received multiple rounds of defibrillation and medications. Despite the exhaustive interventions, her heart ceased to restart. With heavy hearts, we made the difficult decision to cease resuscitative efforts and the time of death was solemnly called.

A profound sense of loss enveloped us as we mourned a young mother’s life that had been lost, leaving behind her newborn and a broken family.

After a solemn moment of reflection to honor her life, we opened our eyes to find the trauma bay scattered with the remnants of our tireless efforts and the emotional turmoil of its fallout. Tears welled in every eye, a testament to the depth of our shared sorrow. Despite our unwavering dedication to save her, we had failed. A sense of inadequacy lingered, as if we had fallen short of our mission to save her. 

The emotional burden of working in the ED

Summoning our collective strength, we gathered ourselves to inform the family of the events that had transpired. Their sorrow quickly unfolded as the husband and mother walked into the room. They crumbled at her bedside, their harrowing screams and cries reverberating throughout the room. 

Overwhelmed by the intensity of their pain, we had to momentarily retreat to regain our composure again, before returning to offer what support we could. Amidst the lingering sadness, we were puzzled by her cause of death. It wasn't until several days later that the coroner's report shed light on the tragedy, attributing her demise to a spontaneous coronary artery dissection of her left anterior descending artery. 

The revelation left us with a sense of bewilderment, demonstrating the fragility and enigmatic nature of life.

This was one of the experiences that taught me about the peculiar emotional burden that emergency physicians assume. The ED is a fast-paced and stressful environment where physicians have to constantly switch between life-and-death situations and the routine demands of patient care.

Every day, emergency physicians must navigate complex emotional terrain. I believe we do this with grace, and these experiences exemplify our unyielding dedication to our patients and our ability to confront the most toilsome challenges of our profession.