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Emergentology: Goodbye for now : Emergency Medicine News


EP life, COVID-19, burnout


I’m eight days late writing this column. I don’t have much to say at the moment. (Strike that out. I have a lot to say, ask my colleagues.) But none of this is more productive.

I’ve been writing this column for 10 years, if you can believe it. I started right after I graduated in residency, just before my 31st birthday, and now I’m writing what is, at least for a while, my last column, just after I turn 41.

It has been an absolute pleasure to have a space to express my thoughts and feelings over the past decade. As I scroll through my 120 columns, I don’t know if I had a clear theme, but I thank my editor, Lisa Hoffman, for giving me the space to say what I wanted to you readers. It’s been a privilege to have your eyes peeled for a few minutes every month (fully acknowledging that it’s probably while you’re looking for something to keep you up at 3:47).

I really wanted to have some sort of deep reflection on emergency medicine or what I’ve learned writing about medicine for 10 years, but unfortunately COVID took that away from me too.

Out of ideas

I just don’t have anything insightful or interesting to write about these days. I keep a list of topic ideas on my phone and haven’t added a single one in months. I don’t want to write about COVID; I’m tired of him. I don’t want to write about vaccination; I’m exhausted. A few months ago I started seeing reports of the delta variant on social media, and it was like reading about COVID decimating Italy in February 2020. Wanted to believe we had learned our lesson and held on account for a warning or two.

There is a quote wrongly attributed to Winston Churchill (it was actually said by Israeli politician Abba Eban long after Churchill’s death): “You can always count on the Americans to do the right thing after trying everything else. It seems applicable here. It is ironic, sad, depressing, frustrating, infuriating, disgusting, pitiful, silly, selfish and mind-boggling to see vaccination rates increase seemingly only due to hospital overflow and unnecessary patient deaths. Is this what we have become?

In our time when we need it most, when our healthcare workers literally begged people to do this one thing safely to help others and prevent hospitals from being overrun again, we have fallen to flat stomach. It’s like we’re about a third of a way through a 5k run and we’re like, “Yeah, that’s tough! I’m out of breath! Why don’t I walk the rest of the way? If this were a zombie movie, USA would be the clueless guy wearing headphones and eating Twizzlers, completely unaware of the approaching horde. Died within the first three minutes of the film.

Whenever I write these columns, I always want to have a solution at the end: “OK, Graham, you spent the last 750 words complaining, so what should we do if you were in charge?” I don’t really have an answer.

Not a bot

All of us in emergency medicine are injured. Damaged. Tiredness. Upset. Disappointed. I look at some of my columns with naivety, thinking, “Wow, you thought things were bad back then? Wait!” I haven’t slept well since March of 2020. I’ve seen doctors and nurses go from standard mild annoyance at a ridiculous main complaint to immediate, vocal anger.

It’s hard not to be frustrated. Patients don’t really understand or seem to care that their doctors and nurses are going through a tough time. Unfortunately, I think we’ve taught them that they’re always right, that anything they consider an emergency is an emergency, and to keep them happy, it’s appropriate during a pandemic to come to the ER to not anything, anytime. I’m not sure I agree with that anymore.

And maybe, to end with a solution, I’ll end with this: it’s important that we talk about what we do, and it’s important that we share our stories, our thoughts and our feelings. The old medical mantra of “don’t share; keep it inside” is a failed approach of human beings trying to heal other human beings.

Psychiatrists have therapy sessions to help them deal with the burden they carry from their patients, and if the medical system wants to keep its doctors and nurses (and not just burn them), we need to have a place to share , connect, celebrate , and even cry with each other. Ironically, the same complaints we all share: “I’m not a doctor robot; I am a person” – exist because we are part of a system that exists to fix problems, not to help humans.

A final thank you to all of you who have read my columns over the past 10 years, to Emergency Medicine News and my editor, Lisa Hoffman, to my husband AJ, and my parents who always encouraged me to be curious and try to make sense of this strange world.

you can find me @grahamwalker on Twitter always trying to make sense of the world and also sharing sarcasm and memes.

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Dr. Walkeris an emergency physician at Kaiser San Francisco. He is the developer and co-creator of MDCalc ( medical calculator for clinical scores, equations and risk stratifications, which also has an app (, and the NST (, a necessary number tool to deal with to communicate pros and cons. Follow him on Twitter@grahamwalker, and read his past columns on