The Allure of the Emergency Department
For most people, the red and blue flashing lights of an ambulance signal that something has gone awry. To most people’s ears, that distinctive siren’s piercing wail heralds a visit to a place we never want to go. For most of us, that big, dominating red sign with ‘EMERGENCY’ plastered across it is something we never want to see.
Emergency departments are loud, chaotic, busy and emotionally charged. Life and death is a daily affair, and tensions often run high – amongst staff, patients, families and loved ones. It is a workplace like no other. While not without its opponents, the emergency department possesses an undeniable allure that very few other places can lay claim to.
So what is it that attracts so many young doctors, nurses and other healthcare workers to a career in emergency medicine? And after they’re in, what keeps them coming back?
For Dr Jenny Jamieson, an emergency registrar working with the Australasian College for Emergency Medicine, it was several things. Excitement, diversity, high yield of care and international opportunities made emergency and acute care her ideal career path.
Having worked with Médecins Sans Frontières in Afghanistan and as a senior clinician and clinical educator in Tanzania, amongst countless other experiences and no shortage of accolades, Dr Jamieson is no stranger to success. But the motivations behind her successes will be familiar to many young medical students, doctors, nurses and others.
‘I wanted something that really encompassed everything, from minor surgical procedures to medical practice. I couldn’t see myself being a single-system specialist, and I was searching for something not only diverse, but where I could really make an impact,’ she begins.
Indeed, there are few careers more exciting and diverse than emergency medicine. From heart attacks and strokes to trauma and mass casualty – admittedly with the odd common cold thrown in from time to time – the emergency department has it all. But Dr Jamieson wasn’t quite satisfied with all that. For something extra, she looked beyond Australia’s shores.
Much of Jamieson’s 2012 was spent working with Médecins Sans Frontières as the supervisor of the new intensive care unit at the Kunduz Trauma Centre in Afghanistan. There she was exposed to a host of injuries and presentations vastly different to home, and dealing with high-grade trauma – blunt, penetrating and blast – became a day-to-day affair.
‘It’s something you don’t really see back home in Australia, a blast injury, but not uncommonly we would see and have to manage the result of an IED – a child who had stepped on a home-made land mine, for example.’
Contrasting starkly with the severity of the injuries seen at the centre were the facilities, which were a world away – literally and figuratively – from Australia. ‘There were no resources, no protocols, and no experience in the field. We essentially had to start from scratch.
‘We had four ventilators which we had to use with the principle of justice in mind: that is, we tended to reserve them for younger patients with fewer comorbidities, which is very different to how we allocate ventilation or ICU beds in Australia.’
The lack of ventilators where Jamieson was working brought the age-old ‘trolley problem’ to life. But instead of answering the problem theoretically, here decisions had real life consequences.
In such situations, pragmatism wins out: ‘of course, these decisions can be incredibly difficult to make’, Jamieson says, ‘but in essence you have to think about the likely outcome in providing limited resources. In many circumstances you really have to give it to the person with the best chance of surviving and having a good outcome.’
This idea lent our conversation a very real dimension. The seriousness and enormity of Afghanistan’s political, economic and social instability – and its human impact – suddenly came to life.
Dr Jamieson’s wish to pursue a career where she could make a difference had certainly been granted, but such responsibility can take its toll.
‘At times you can’t help but think that if certain things happened in a country like Australia the care that you would be able to provide would be very different.’ Unfortunately, for many people, health outcomes – even life and death – are out of their control. Their fate lies not in their own hands, nor in the hands of doctors, but in the hands of circumstance.
As is often the case, it was a simple story that brought her point home. ‘I remember treating one man who was on warfarin who came in with a simple blood nose. Despite our best efforts, he ended up bleeding to death. There was just nothing we could do. Without blood products or the appropriate resources, stopping the bleeding just wasn’t possible.’
Even in the context of such a gruesome conflict, it was this story that stuck with me. The atrocities of war are unconscionable and often unfathomable, but the stark injustice of having someone die from nothing more than a blood nose – in hospital – is something we can all relate to, and all feel appalled by.
Dr Jamieson’s experiences in Afghanistan, Tanzania and back home in Australia made for incredible listening, and marked an impressive and remarkable (to say the least) career. Diverse and exciting were the words she used to describe her work, and it would be pretty hard to disagree.
‘We’re lucky in Australia to be leaders in emergency medicine, and that’s something we should be proud of. We were one of the first countries to advocate for adopting emergency medicine as a separate specialty, and our training program and level of service reflects that.
‘Put simply, it’s exemplary.’
When I asked if she would ever consider following any other career paths, I was met with a resounding no. While certainly not all glitz and glamour, that allure of the emergency department came through loud and clear as Jamieson spoke of her career, its ups and downs, before finally coming to a simple piece of advice for medical students and young doctors.
‘If you think emergency medicine might be your thing, go on – make it yours.’
And if all this lies in store, why wouldn’t you?
The views and opinions expressed in this article are those of the author and do not necessarily represent those of the Doctus Project.