A Day in the Life of an Emergency Physician

emergency physician

Post written by Yogin Patel, MD, MBA, ApolloMD CEO

ApolloMD is a privately held, independent group practice owned by our physicians, APCs, and employees. As a clinically led organization, our executive leadership continues to work on-the-ground clinical shifts at many of our hospital partners, including Dr. Patel, ApolloMD CEO. He composed a personal narrative as he reflected on a recent shift in the ED. 

An overly familiar alarm buzzes at 4:20am. My first thought is “I should have slept more”. I lazily brush my teeth with the combination of spearmint and reflux mixing in the back of my throat. Heavy arms and legs, I wearily climb into scrubs in the dark and carefully exit the house – a thief in my own night.

The pitch-black drive is less interesting this morning. News radio in the background drones on about the ongoing conflict and controversy of the world. A quiet 45-minutes on country backroads solemnly foreshadows a heavy day.

I arrive 20 minutes early, as planned. My grandfather’s voice echoes in my head, “if you’re not early, you’re late”. A walk across a mostly empty parking lot before the first rays of morning light flicker onto the red EMERGENCY sign. I scan my badge at the door, and it slides open, welcoming me as it has for the last 12 years.

Post-pandemic health care

I walk through a deserted hall passing a row of portraits of current and former medical staff leaders. These solemn witnesses, the Hall of Chiefs, are reminiscent of the ghosts of Christmas past – I think to myself, we proudly had four members of our group serve as Chief of Staff over eight of the last ten years. I’m thankful for the leadership they brought to these halls and their advocacy for our clinicians.

emergency department sign

I push open the emergency physician department door that has a sign proudly announcing renovations will begin. I’m glad they’re finally coming. I walk into a well-worn department and remember when our team came in a few years ago to re-paint the walls. The paint, now peeling and the walls, battered and bruised, reflect the weight of a post-pandemic health care system.

Get the night guy out

A jumble of beds, wires, and carts line the hall. Thankfully, I only see two patients waiting for beds at a quick glance. I notice several familiar faces from my last shift two days ago.

The nurse station is a quiet hive – the night shift  running on the last fumes of caffeine as they await the final grains of sand in their hourglass. I offer a smile and walk into the doc box. As I’ve always done – Cardinal Rule #1 – “Get the night guy out.”

An all-too-familiar routine starts. I wipe down the mouse and Dictaphone with chlorhexidine wipes. I open the printer and grab a plain sheet of unlined paper on which I’ll record the souls that I touch today. And I’m off. Dental pain in a young man with decaying central incisors and multiple eroded teeth. I can’t provide him the extractions and dentures he desperately needs, so I offer a dental block and antibiotics as a consolation.

Meet patients where they are

I weave between acute and chronic back pain patients to find a dialysis patient desperately short of breath. Her lungs are drowning in their own fluids. She’ll have to be admitted to dry her out, so I start the workup and make the ask. Several patients with Covid symptoms begin to check in and I strap on a mask and a prayer as I run out to triage. I try to see these patients on arrival to keep them from coming into the Main ED and creating an exposure risk for our team. Cardinal rule #2 – “Meet patients where they are.”

Several car accident patients later, I return to the desk for a brief respite. I rattle out some dictations and tap out the clicks that will define these encounters. I’m only two hours in. 

emergency room

Respect the team

As the static-filled EMS radio sparks to life, a well-loved EVS tech comes in to clean the doc box. I look up at her as she moves gracefully through the room – the most tenured employee in the entire hospital. She has been a treasure for decades and I’m in awe of  her work ethic and commitment over the last 40 years. I move the chairs and watch as she cleans out our office with an efficiency that comes with experience. I thank her profusely for everything she’s done, for asking me how I felt, and more importantly, for her caring. Cardinal rule #3 – “Respect the team.” And everyone is on the team.

The afternoon is filled with patients with intractable vomiting, patients gasping for air arriving by ambulance, and the elderly being shipped from nursing homes for failure to thrive. What does thriving in a local nursing home really look like? I shake my head. The rhythm of the shift prevents you from having to dwell on these existential questions.

One hand giveth, and one hand taketh away

A case of right lower quadrant pain in a kid that’s less appendicitis and more constipation. A schizophrenic patient trying endlessly to win an argument with the voices in his head and a homeless man feeling despondent and depressed. What homeless person doesn’t feel despondent and depressed? As I’m walking back to chart, a patient arrives by ambulance gushing blood from her nose with blood pressure in the 200s. And of course, she’s on an anticoagulant. Cardinal rule #4 – “One hand giveth, and one hand taketh away.”

A calling and a deep privilege 

Patients post-op from recent surgeries, patients whose primary care offices are closed on the holiday, patients with nowhere else to go and no other resources – we proudly see them all.

Our ministry is for all in need, with no questions asked. It’s always been a great source of comfort and pride for me. We come to work and try our best to suspend judgement and simply listen and treat. This is a calling and a deep privilege. 

My partner comes on to relieve me and I offer a weak salute. I grab my bag, return the phone, and walk out of the ED. Working on this Monday, a holiday, I remind myself that it is a privilege to be alive, to be whole, and to have had this opportunity to serve…. and I would do it all again in a heartbeat.

–Yogin Patel, MD, MBA, FACEP

Click below to read more about Dr. Patel or follow him on LinkedIn.

Yogin Patel, MD, MBA, FACEP

Dr. Yogin Patel Is Named CEO of ApolloMD

2023: Celebrating a Year of Advancement, Innovation & Growth

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