I remember the very first time I did CPR on somebody. It was a young person who died from an opioid overdose. I was a 16-year-old kid, and a volunteer on our town ambulance squad. I went home that night and, as I was sitting down to dinner, I was like, “How do I eat with these hands? I did this thing on this person and he’s not alive anymore.” It was a very profound moment for me of realizing the full spectrum of life. That really stuck with me.
Being on the ambulance squad meant that all my interactions with medicine were in the emergency room. I just couldn’t get enough of it. The summer before I went to college, I got a job as a clerk in the emergency room at Valley Hospital in Ridgewood, New Jersey, close to where I grew up. I would go home on all my breaks and work a full-time schedule. I saw physicians working in the ER and that was my dream. They were kind of my idols of what I wanted to be when I grew up. I would take in as much as I could about everything that was going on.
A lot of people have a sensationalized idea of what it’s like to be an emergency physician because of TV. The vast majority of what we do is not life-threatening emergencies. Most of the cases are abdominal pain, chest pain, dizziness, and vague symptoms where we have to figure out what it is, like solving mysteries.
People use the phrase “organized chaos” for what the ER is. There’s a ton of people around, there’s all sorts of alarms, there’s noise. Depending on where you work, you could have emotionally distressed patients, you can have people in pain. There is so much stimulation. And, you have to somehow learn how to live in the midst of all that and still maintain your ability to really pay attention to people. Even when you’re in a conversation, you always have to be listening to everything around you — listening for the subtle clues, the change in that alarm or someone moaning differently than they did five minutes ago. You have to be totally aware of your surroundings at all times.
Even in kindergarten, I can remember saying, “I want to be a doctor.”
My mother was originally an ER nurse and when I was 5 years old she switched to school nursing. She also volunteered with the ambulance squad. When she would go out on a call, I’d be waiting for her to get home to tell us about it. I was always fascinated.
As soon as I was able to, I joined the squad. I took the first part of the certification course the summer before I turned 16. At the time, I was also doing a community theater production. So, I was in rehearsals with all these other teenagers, and I would be sitting in the corner of the auditorium reading my EMT book and studying while everybody else was socializing and hanging out because I wanted to do this so badly.
My birthday was in August and my mom and I put ourselves on call that day. The first call was someone having acute heart failure. We left our house with a little blue flashing light on the car, and then got the ambulance. My heart was just racing. I saw all these medical procedures and we took the person to the hospital and it was this huge high. That was probably a pivotal moment for me in realizing this is what I wanted to do with my life.
There was this moment about five years into my career when my father got sick and I experienced medicine from the other side, as a family member. His disease spread and they were going to stop treatment. At that appointment, it felt like there was no holding his hand, just this impersonal, robotic speech: “Mr. Egan, the cancer is going to take your life.”
I was so angry. I realized we have to bring in the human piece of medicine more. People relive those moments over and over in their heads — I know my father did — and it’s just one of those things I’ve really tried to focus on. I have to break bad news not only about death, but also about a diagnosis someone isn’t expecting. How do you do that and provide compassion? There’s that piece of forgetting the doctor thing, forgetting the white coat thing, and just being another human being.
I had been working in emergency medicine in New York City for 14 years. It hit me that something bad was happening when we started to hear about COVID-19 cases on the West Coast. When I saw the uptick in New Rochelle, just outside New York, that was the moment that I was like, “It’s here. Are we ready?”
All of sudden, it was a tsunami. There were all these patients and everybody coming in with symptoms that seemed like they might have it, and we were realizing it was so widespread we had to assume everybody had it. Overnight, our world changed.
In the beginning, there was a lot of fear and anxiety. “What’s happening? Am I going to get sick? Are my colleagues going to get sick?” There were so many questions. There was also this sense of pride for our specialty. This is what we do. We respond to disasters. We mobilize and we just go with it. But this was a whole new world. Everyone kept saying, “This is a sustained mass casualty incident.”
We were wearing masks and goggles and protecting ourselves from every single patient. When you walked through the ER, everyone had an oxygen mask on. We had recliner chairs all along the hallway with people who were on oxygen. There were a ton of people on ventilators. We didn’t have anybody who was there with belly pain. They just disappeared. It was the strangest thing in the world. I remember I sent out a tweet in the beginning, “Where have all the gallbladders gone?” I just wanted a gallbladder. Everybody was there for COVID. It was crazy.
There were a ton of phone calls. Before the pandemic, families were there and it was helpful, but now, with literally no visitors, people were calling nonstop. We had this really increased level of awareness that we had to make sure families felt like they could talk to and hear from us. I would do my best to have these conversations, even just for updates. When I could tell them I knew who their family member was, that they weren’t an anonymous patient alone in a corner, that I was taking care of them, there was always this huge, palpable sense of relief.
The hardest thing was not being able to answer people’s questions well. Normally, you know what’s going on with someone. I’ve got years of experience in dealing with certain diseases and can realistically tell families what’s going to happen. This was the new unknown and it was so hard to be able to give people any kind of reassurance.
I had a younger patient whom we had to put on a ventilator. I called his wife and was trying to convey the message that he was really, really sick and that we needed to put him on a ventilator. This was really early on, when family could not come inside, so I let her talk to him by phone. I didn’t know if he was going to survive. He was younger so I was thinking maybe he would. But I didn’t have the sense she was totally processing how bad this was.
About 10 days later, I looked him up and saw that he had died. I thought, “Oh my gosh, I saw their last conversation.” And I don’t think it was how she ever imagined her last conversation with her husband being. He was in so much distress that he barely said anything. I remember that case vividly. Not being sure what to tell her, not being able to predict what his course would be, and just being really shaken when he didn’t make it.
In the ER, we all are wondering when, and if, life will go back to normal. Certainly, the recent surges and cases elsewhere in the country are making us all really anxious in this part of the country. We’re still wearing masks all the time. We’re getting badge-size pictures of our faces smiling because there’s this loss of human connectedness when you can’t actually see someone’s facial emotions. When I walk into a room, I like to smile and laugh and shake hands and all of that’s gone. And it would be really upsetting to me if that doesn’t ever come back. We’ve talked a lot about the whole human piece of this and the attentiveness and I think a lot of people were really affected by it. I think it’s going to be on all of our radars in the future to take that extra minute to try and engage the family, to make sure patients are not feeling alone.
This summer, I became the program director of the Harvard Affiliated Emergency Medicine Residency, which is where I actually did my residency. There’s something about working with new doctors that’s inspiring and brings me back to the fundamental core of why I went into medicine. To see their optimism and excitement for the future is invigorating.
One of the things that’s really hard in emergency medicine is there’s a lot of burnout. I tell residents when they first start out, “You’re going to see more tragedy, as well as awesomeness, in your first couple months than most people will see in their life.”
Looking forward, I think the passion and joy for me is about working with the next generation of physicians and being involved in helping to shape them as doctors.
In the emergency room, you see everything — a spectrum of ages and disease, people who are homeless, people who don’t have access to care so they come to us for a medication refill. You see people who are dying or having strokes or heart attacks. It’s truly the entire spectrum of medicine and society.
I think the pandemic has highlighted the importance of emergency medicine and the people whose job it is to respond to a crisis. There’s a huge amount of pride in who we are and what we do. We go to work and sacrifice, potentially, our own well-being for other people.
I keep telling people that for the rest of our lives we’re going to be talking about having lived through this experience and what it was like and how we got through. For many, it’s going to be a pivotal moment in their careers. Some people are going to say, “This is too much.” Others are going to say, “This is why we do this, to be here when the world really needs us.”
Words by Daniel Egan ’98, as told to Liz Leyden for TCNJ Magazine
Pictures by Bill Cardoni