I AM the Emergency [Clinics Series]

The small animal emergency rotation is split into two shifts: daytime shift (aka triage) and nighttime shift (aka ER). For each shift, there are designated “receiving hours” during which incoming patients are assigned to a student on the shift. From there, patients may be treated immediately, temporarily housed in the ER while awaiting diagnostics, or transferred to another service within the hospital. You, as the student, are allowed to leave at the end of your receiving hours IF all your patients are settled in for the day – in other words, they have either been sent home or transferred to another service. This includes completing the associated paperwork. That sounds simple enough, but it can easily get out of hand depending on how many patients show up that day, how sick they are, and how many other students are on the rotation to share the caseload with you.

I started the rotation on the nighttime shift, and I loved it. Receiving hours were from 4pm-12am, and I left at 12am half the time and 2am the other half. Either way, I still got 7-8 hours of sleep most nights, went running, had lunch with friends, and had productive, educational shifts in the hospital. But this was not to be maintained when I switched to triage. When you’re on nighttime shifts during the week, you’re on 12-hour shifts on the weekend. I had the 12pm-12am shift, and finished at 2am both nights. That would have been fine, except that I was transitioning to daytime/triage on Monday, so I ended up being at the hospital 12pm-2am on Sunday and then had to report back to the hospital at 6am on Monday. Less than four hours of sleep could have been manageable, I suppose, if I had time to recover, but my shifts on triage were never shorter than 14 hours long. All told, I did seven 14-15 hour days in a row.  There was very little learning or teaching that week, because this overworking problem is systemic – the clinicians, residents, and interns were usually there just as long or longer than I was.

I can hear you. You’re scoffing at me and telling me to suck it up. This is the way emergency has always been. This is the way human medicine is too. Every week, all around the country, there are people working 100+ hour work weeks. If I can’t handle it, then clearly I’m the problem, because everyone else is just sucking it up and dealing with it. Right?

About halfway through the week, a friend from the class under me asked how ER was going. I told her that I was so tired that I no longer felt tired, much in the way that your stomach will stop growling eventually if you don’t get the chance to eat something. This experience has helped me gain a better understanding of why people don’t fight back against these insane schedules – you’re just too numb. You’re expending all your energy on just surviving and you don’t have any left to stop and say, “Hey, this isn’t healthy.”  But just because ‘everyone does it’ doesn’t mean that we should.  Sure, we can do anything for just a week/block/year, but I suspect that sets a really bad precedent.  If you’re always ‘just surviving,’ when are you learning? When are you maintaining your relationships?  Will it only be time to be happy once you’re done surviving?  This is a situation that’s literally killing us, and it has to stop.

I’m thankful for the wonderful week I had on the nighttime shift. I’m thankful for the clinicians (one in particular) who were helpful and patient. I’m thankful for the coordinator’s willingness to let me rearrange the very beginning of my nighttime schedule to accommodate a personal event. I’m thankful for the other students on the rotation with me, because they didn’t let me fake that I was ok. I’m thankful for my courageous friend, who is facilitating a class-wide discussion on this topic. I’m thankful that I live in a time when mental health is increasingly recognized as an irrefutable component of health. And finally, I’m thankful that you took the time to read this post!



This post is part of a series documenting my clinical year in veterinary school.  To read more from the series, please visit the Clinic Series homepage.

2 thoughts on “I AM the Emergency [Clinics Series]

  1. The burnout rate among emergency medicine physicians is, at last count, north of 90%. I am sure veterinary medicine is no different! Systemic problems, indeed.

  2. Pingback: 2016 Blog Round Up | The Other Side of the Desk

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