Death of a Thousand Cuts

I used to play Magic the Gathering. For anyone new to the program, I’m a giant nerd. I start with this because my brain periodically spouts useless dork-trivia at random times, which, occasionally, is helpful.  Read the bonus text on the bottom.

Also, this is a pic of me after a shift hearing about a 14/10 pain after a stubbed toe.


“Great losses often bring only a numb shock. To truly plunge a victim into misery, you must overwhelm him with many small sufferings.”

I tried to understand what causes burnout. Why do certain professions have such a high burnout rate? Then, like a slap in the face by a decomposing salmon, I realized not one thing caused it. No! The combination of several factors is what drives this overwhelming frustration.

I need to rant a minute…

Is it being understaffed? Yes, sometimes.

Is it angry drunks being jerks to staff? Yes, sometimes.

Other times, it’s admin adding yet another non-essential element of idiocy that we as providers must perform for absolutely no discernible reason.

For example, providers used to be able to order medication, and then the nurses would give this medicine to patients. Seems simple, and the system worked.

Now, we must list if the patient is in mild, moderate, or severe pain. If the amount we desire to give does not match the arbitrarily chosen amount associated with that pain level, then the nurses must discuss with the doctor to either change their order or adjust what the level of pain is listed as.


So if a patient has a kidney stone and appears in AGONY, but I order Toradol which (from experience with my kidney stone) works well but only is for mild pain, the nurse has to check/double check that I really want that and admin might give me a nasty-gram.  However, I can easily give high concentrations of narcotics. Sigh.

Oh, oh, oh, don’t get me started on customer satisfaction.

That’s right, patients are not “patients,” they are customers.  And like the diabetic patient recently seen, terrible decisions have no impact on a patient’s interpretation of consequences.

Picture this.  A physician walks into an exam room.  The patient sits on the cot, fingers covered with powdered sugar remnants from several donut holes, as well as a 96oz Mega-Gulp of Coke. The patient then complains how the “stupid doctors just can’t seem to get his diabetes under control.”

Now picture this. An elderly woman wants “everything done” for her 139-year-old husband with CHF, COPD, asthma, consumption, asbestos, and the black-lung. His O2 sat is currently in the upper 70’s.  He needed to be intubated about an hour ago… BUT… she wants me to contact his geriatrician before she will allow me to intubate him. She’s the DPOA. So, do everything AFTER I have the go ahead from someone who likely has not intubated a person in the last 20 years. By some divine intervention, I get a hold of the geriatrician who (of course) says “YES, PLEASE FOR THE LOVE OF SANITY LET HIM BE INTUBATED” to the DPOA.

Now picture this. A very old woman, naked, stands in her room repeatedly raising and lowering the chair in the room as if she is doing calisthenics while staring at me. Shockingly, she’s in the ER for a psychiatric complaint.

It is a mountain of insane complaints and requests that are so nonsensical they’d be funny except that the patients are serious.

Ooh, that reminds me of another quote I heard.

This is not made up.

These are actual quotes overheard in an ER near you.

Patient: “Hey doc, are these Norcos gluten free?”

Doc:  Wait, What?

Or possibly the answers to seemingly simple questions.

Doc: Any history of drug use.

Patient: Absolutely not. Never. Well, sometimes I do crack, but that’s just when I have lots of laundry to do.

And, sometimes, the general lack of simple knowledge seen throughout our careers.

Doc: How many times have you been pregnant?

Patient: This is my eighth. You know, early pregnancy’s run in my family!


So yeah, I guess I understand where sometimes a little bit of burnout can arise. However, there’s no other specialty that has nearly the fun and craziness.

Personally, I love it, and to do it over again, I’d be ER every time.



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