The girl was only four years old and she had a bullet wound.
The moment Dr. Ian Cummings saw her in the ER seemed to last a lifetime.
But only seconds later, he pronounced her dead and began work on the girl's
babysitter, who still had a chance to make it.
"I couldn't help but think of my own daughter who was four at the time,"
Cummings says. "That's the thing about working at this hospital. It's a small
hospital and if anything were to happen to my family or friends, they'd come
here."
An emergency room physician in Putnam, New York, Cummings admits that particular
case was far from typical, even though TV shows like to make
it look like an everyday occurrence.
"It's not that glamorous, really," says Cummings. "It's a love-hate relationship.
It's very fast paced -- a true generalist's specialty. You see everything.
Plus you get rapid feedback, and you get to work with your hands doing things
like wound repairs. Sewing a kid's face that's been bitten by a dog -- that
takes a bit of art and a bit of technical training."
Cummings has become a media favorite on health issues, drawing attention
from CNN and even the National Enquirer. Both have featured Cummings downplaying
the hype of TV emergency room shows.
"That was the low point of my career," says Cummings, who includes a clip
of the National Enquirer article on his home page.
"The shows tend to overplay how much excitement there truly is. It's not
like every 30 seconds the door opens and someone's there with a butcher knife
sticking out of their back. You do get some people with grievous injuries,
but you do a lot more working with elderly patients with pneumonia, or kids
with ear pain. There's a lot of mundane stuff."
On a typical shift, he sees between 40 and 50 patients. Of those, about
10 people would be moderately to severely ill. "It's hours of boredom, punctuated
with moments of sheer terror," Cummings says.
It takes a special type of person to work in an emergency room. Aside from
the obvious ability not to faint at the sight of blood, emergency room physicians
have to be comfortable with the fast pace.
"People tend to self-select in medicine," says Cummings. "This attracts
a high-strung type of person. They enjoy instant gratification and would probably
do less well with an office-based practice. Plus, you can't be someone who
is easily flustered or rattled."
The job is also physically demanding. You're standing up for hours on end,
and walking from room to room. As an experiment, Cummings put a pedometer
on himself once and clocked over 25 miles in one shift.
For Dr. Janet Nuth, the tough part comes with seeing the human condition
at its worst. "You see people strung out on drugs or alcohol, people who are
severely intoxicated. I've also known doctors who have been hit by violent
patients."
The emergency room isn't the place where you establish a rapport with your
patient. As a result, sometimes a doctor can feel under-appreciated, Nuth
says.
Then there's the sheer intensity of the work. "Lots of time you feel like
you are drowning -- just keeping your head above water. Most studies show
that there are high degrees of burnout."
Nuth recommends that people entering the field have strong support from
their family, or have another outlet for the inevitable psychological challenges
of the job. "Telling a set of parents that their four-year-old child has leukemia,
or that there was a terrible accident and three people were killed -- you
can't deal with that kind of thing without support."
At the same time, Nuth says the work is extremely rewarding. The diagnostic
challenges keep the job interesting, and sometimes you're able to even save
lives.
"Every patient is a puzzle you have to figure out. Someone comes in, in
a coma, and you have to try to figure out what's going on -- you're the one
that puts the puzzle all together. It's very rewarding."