Civilian Casualties

As an ER doctor, I often meet people on the worst day of their lives.  I’m the guy who gets to tell you your mom is dead.  I’m the one who works the futile code on your 4-year-old while your screams cut right through everyone in the room.  I find your cancer.  I tell you your husband overdosed in the McDonald’s parking lot.  When you decide you want to shoot yourself (but chicken out at the last second so the gun just blows off your face), I’m the guy picking the tooth fragments aside so I can intubate what’s left of you.

Sometimes I get to witness the worst things people can do to each other.  Assaults, rapes, child abuse cases, human trafficking – guess where they all end up day or night?

I suspect many of you reading this witness equally horrific things.  You inevitably developed some defense mechanisms otherwise you would have quit long ago.  You compartmentalize.  You flip the detachment switch on and do your job as effectively as possible.

Every once in a while you may be tempted to give your non-medical friends and family (civilians) a glimpse into what it is you do.  This is a double-edged sword.  It may be cathartic to let them in on what you’ve seen, but they’re not equipped to handle it.  You’ll either leave them traumatized or even worse – they’ll think you’re heartless for being able to speak about such depressing things without flinching.

Even marble has its breaking point.

Even if you don’t fully expose the civilians in your life to the things you’ve witnessed, these tragedies still take their toll.  If you’re not careful, you’ll leave a trail of civilian casualties in your wake.  Here are a few of the civilian casualties in my life.

My Spouse

Some days my wife gets the very best of me. Other days she gets what’s left of me.  She knows me better than I know myself and she can usually tell when I’ve had a particularly bad day at work.  I feel very lucky to have married the right person.

#1 Life Hack: marry the right person.

Decision fatigue – Do you ever have a shift where by the time you get home you have lost the ability to make even the simplest of decisions?  At first my wife liked that I always let her have her way, but it quickly got old.  A grow man really should be able to pick a pizza topping in under 30 minutes.

Zone Out – Some days I get home but my mind is still replaying the shift.  I’ve mastered the art of the husband conversation.  Eye contact.  Nod.  Repeat a few key words.  Interject with just enough questions to indicate I’ve heard what was said.  Unfortunately, it all falls apart two weeks later when it becomes abundantly clear that I have no memory of agreeing to host a dinner party for 20 people.

A doc in the streets, wide awake in the sheets – I don’t even have to tell my wife if I’ve seen something that got to me.  My tossing and turning is a dead give away.  One time I had a bad pediatric code and I didn’t tell my wife about it for two weeks.  When I finally told her she said:  “I know.  I’ve been waiting for you to be ready to talk about it.”  That was her polite way of saying “if you keep me up one more night I’m going to smother you with this pillow”.

My Kids

If you think I tell my kids about the things I see at work, you’re nuts.  My kids are 8, 2 and 1.  My 8-year-old daughter is interested in hearing about people needing stitches, but that’s about as graphic as it gets.  Just because I keep my kids in the dark doesn’t mean it doesn’t impact them too.

These kids need you whether you had a bad day or not.

Too many patients, not enough patience – Parenting is the hardest job on earth.  It takes patience, understanding and the ability to withstand a cacophony of crying, whining and nonsense.  There is no doubt I am a better parent on my days off.

Where’s the gratitude? –  Kids are kids.  It is their nature to be self-centered.  Somedays I get frustrated with my kids for not knowing how good they’ve got it.  It’s not my 2 year old’s job to know that some kids live in cars with addict parents.  He’s too busy making fake fart noises and laughing hysterically.

My Friends

Most of my friends aren’t doctors. They’re teachers, social workers, graphic designers, and scientists.  One of my best friends has had a string of corporate jobs that boil down to getting paid 6 figures to play Candy Crush in a cubicle.  He recently got a promotion and now he gets to play Candy Crush remotely from home.

All humans are the same. We all like to complain about our jobs. I have a pretty high tolerance for my friends whining, but every once in a while I give them perspective.

After listening to a friend complain for the fifth time about how boring a work teleconference is, I might interject with “nothing like a dead 6 week old to pep up a slow work day”.  It never goes over well and I regret it every time.  When your friends vent to you they just want someone to listen.  They’re not trying to engage in a “whose job sucks more” competition.

Protect the Innocent

It’s not your friends’ and family’s fault you became a doctor.  Everyone needs a way to decompress but dragging civilians into something they’re not equipped to handle is never the answer.  Here are some alternatives to adding to the civilian casualty body count.

Find your tribe – Somewhere out there is a group of people just like you. For me it’s my coworkers.  We can talk bluntly about rough cases without judgement.  We cheer each other up with the darkest gallows humor you can imagine.  The physician bloggers I interact with and members of the White Coat Investor forum have also given me a new sense of community.  Whether it’s face to face or online, there are people out there who understand what you’ve seen.

Write it down – You’d be surprised how much better you’ll feel just simply organizing and writing down your thoughts. I’ve never been a journal/diary kinda guy, but this blog has really helped me process a lot of my thoughts on life and medicine.

Know your audience – When you’re with a group of civilians and they want to hear some war stories, make sure you read the room.  They may think they want to hear about the grossest thing you’ve seen, but they don’t really mean it.  Stick to the classics – I have a catalog of rectal foreign body stories that are always a hit at parties.

Wins the crowd over every time.


Your medical career is a privilege.  We work hard, but we also get the chance to save lives and make a real positive impact on a daily basis.  You are going to see some truly messed up stuff doing this job and you need to find some healthy ways to process it.  Just make sure you don’t drag any civilians into the battlefield.  If you haven’t found your tribe yet, you can contact me.  I promise not to turn it into a whose job sucks more competition.

What do you think? Has your career left civilian casualties in its wake? What steps have you taken to protect the innocent? Share your thoughts and comments below.


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16 thoughts on “Civilian Casualties

  1. Great points SHS. It is easy to get dragged into whose job sucks the most competition at any gathering but there are somethings like you mention that unless you have been immersed in it for some while should not be part of a casual dinner conversation.

    Like you I find blogging a great creative outlet to get what’s on my mind out there and given that the blog is designed in a specific niche those that frequent it fit my tribe quite well.


  2. Another good post. We hosted a huge Thanksgiving event and a handful of hours before was one of the 3 days in my life that I sobbed at work. Really difficult to sympathize with any BS problems after that kind of night. I kept my mouth shut; in retrospect it was self protection more than anything.

    Liked by 1 person

    1. Sometimes it’s easier to flip the detachment switch on than to flip it back off. Most problems seem trivial compared to what our patients go through.

      It’s nice to have people who understand what you’ve been through. Maybe we should open a VFW for healthcare workers.


  3. SHS,

    1) I think this post should be required reading for anyone considering a career in emergency medicine. Or considering marrying an EM doc.

    2) I still have a film folder full of war stories from residency (rectal foreign body plain films included) that was saved until 1am when the hardcore medical voyeurs refused to leave without satisfaction. It was an easy party trick to pull off, and I eventually stopped relying on it, but it was great fun being the life of the party for that reliable half hour in my 20s, especially since I spent most of my 20s in a library.

    3) As my kids (8 and 10 years) have aged, they are more interested in the social problems I encounter in the ED, and it’s been eye opening for them. Why did the man vomit on you, Papi? Because he drinks too much beer and it makes him sick. Why does he that? It’s called an addiction. Why did the lady give up her baby to the people in the ER? Because she was so sad in her life, and she wanted her baby to have a happier life than she thought she could give it. It gets very real very fast, and I’m always surprised at my kids’ ability to follow what happens as well as their attempts to provide support after a hard day.

    4) My solution to the spousal dilemma was to marry a fellow emergency physician, providing a common language at the outset. If you really want to find more of your tribe, plan to attend a FinCon someday. It was terrific, and you were missed.

    I absolutely love your writing style, your penchant for irreverence at just the right spots, and the sprinkling of brutal reality that grounds the gallows humor. Thanks for writing about the experience with just the right amount of affection and skepticism.




    1. I’m honored to receive such a high compliment from someone whose writing I enjoy and respect so much.

      A “sprinkling of brutal reality that grounds the gallows humor” is a great way to sum up emergency medicine.

      I will do my best to continue representing our profession as a combination of privilege, pain and profanity.


  4. The blank stare after a shift or the tossing and turning at night is a common thing in our house. After my first couple years of being an attending my wife said “you don’t tell me cool stories anymore” to which I replied they are either way too common or way too depressing.

    Emergency medicine is an amazing profession but we do carry a load that others just don’t understand. I don’t want them to ease the load but sometimes I need my time to stare off and let the screaming mothers voice calm down in my head.

    I agree with crispydoc about your writing style. You sneak in these posts between practical $ topics that hit home for me every time.


    1. The definition of “cool story” definitely evolves throughout your career.

      We all process the stresses of this job differently, but it’s nice to know you’re never alone.

      Somewhere out there is a fellow doc who can listen to your story and say “that is some messed up 💩”

      Liked by 1 person

    1. I won’t speak for Linus and Crispy but to achieve the proper level of numbness you do need to lose a little bit of yourself. I’m not as sweet, silly and optimistic as the med student who stood in anatomy lab 15 years ago.

      The same skills that let you go to battle every day are the same things that put you at risk for burnout.

      Of course, clinical correlation is advised. 😉


  5. I’m a trauma/surgical ICU RN. I’m and thankful that the ED cleans everything up for us before a patient lands in our unit.
    Although I’m not in the ED, and my wife is a nurse in the same ICU, I rarely like to talk about my day. If it was stressful, talking about it only makes me relive the stress/frustration/whatever. I’d rather leave work and pretend I was never there in the first place, compartmentalizing what I saw and experienced.
    Thanks for the perspective, it was quite insightful.


  6. SHS, I hadn’t read this article until this am….would invite you to read my latest article if you have time….

    I worked ERs back in the 80s…and you guys have my respect and admiration for simply being able to continue to show up to work.


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