As An ER Doctor, I Knew To Expect The Unexpected. Then My Neighbors Began Arriving At The Hospital.

"For all my years of training in emergency medicine ... I didn't know how to process my own [trauma] because I'd never been taught how to do it."
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My thermos held boiling-hot tea, and in my insulated lunch bag was a peanut butter and jelly sandwich. It was the morning after Christmas, and I was mentally preparing myself to work a senior resuscitation day shift in the emergency department — and to expect the unexpected.

The sun’s rays rose over the city through the glass of the pedestrian bridge as I walked from the parking lot to the hospital lobby. In the peaceful quiet of early day, I felt grateful to care for my patients. Life was often quickly thrown into perspective in the resuscitation area. When patients came with critical conditions like strokes, heart attacks or traumatic injuries, nothing else mattered.

The flow that morning was steady. As rooms filled up, people were sent to the hallways. Around noon, a critically ill patient arrived in need of immediate central venous catheter placement to administer lifesaving medication.

At that point in my training, I had done this procedure over 50 times. I prepared the patient and quickly got the ultrasound machine ready. As I held the large-bore needle in my hand — about to enter the skin of the neck above the right superior vena cava — I heard the door slide open. I looked up and saw a face I didn’t recognize.

“Dr. Singh,” said a woman wearing scrubs who was standing at the foot of the patient’s stretcher. “There are patients here from your condominium complex. There’s been a fire.”

I looked up. She appeared oblivious to the patient, the procedure and her inopportune timing. I heard her words but couldn’t let them in.

“Thank you for telling me,” I said softly. “Please leave and shut the door.”

I closed my eyes and inhaled.

The night before, on Christmas, my fiance had come to visit. For over a year, Amandeep and I had sustained our long-distance relationship from Maryland to Connecticut with monthly trips, frequent phone calls and texts. During this visit, we decorated our miniature Christmas tree with yellow lights, cooked a holiday meal and started a game of Monopoly. I felt comfort and joy just being with him.

We had grown tired before finishing the game. I could still picture the open board, paper money and game tokens on the living room carpet.

Back in the patient’s room, I opened my eyes. The glimmer of the catheter needle came back into view. I inserted it correctly, without causing lung collapse.

In a quiet moment later in the break room, I finally had the courage to open a text message from Amandeep that had come in an hour earlier. It was a photo of my condominium building engulfed in flames, with its wooden shingles fueling the fire.

A photo shows a fire at the author's condominium complex in December 2016.
A photo shows a fire at the author's condominium complex in December 2016.
Courtesy of Jessica Singh, M.D.

“I was sitting at the kitchen table in a meeting and the fire alarm went off,” he said when I called. I could hear the sirens as he talked.

“They’ve evacuated the building and want us to go to wait somewhere else. I’ll call when I know more.” My stomach churned.

A firefighter who brought a patient into the emergency room told me that the fire had been large and many of the apartments were destroyed, not only from the flames but also from smoke and water damage. No one was killed or seriously injured, but no one was allowed in their homes. The cause of the fire was still unknown.

I debated whether I should go home, but then I thought, What good would leaving early do? I couldn’t fight the fire. There were more patients to be seen, and they came first.

I was numb, steeped in medicine’s ethos to practice through extenuating personal circumstances. But a few minutes later, I found myself typing into a patient’s chart and I was unable to think. My body flushed with heat.

I hid my tears from my attending, but she still sensed my distress.

“Only we [physicians] could work through anything,” she said.

I managed a weak smile. Was this laser focus a good thing? Was I deluding myself? Even as I tried to wall off my own humanity, I couldn’t do it.

The rest of my shift was a blur. I don’t remember the patients I cared for, or how the work got done. At the end, I drove home to the condo, past the firetrucks, their red and blue lights illuminating the dark night sky.

I tasted salt on my chapped lips as I climbed the wooden steps to the clubhouse on the other side of the condominium complex where my neighbors gathered. I found Aman sitting in a corner, looking for a hotel on his computer.

When I collapsed into his hug, the news finally sank in. I would never again enter my home. Aman and I would not be playing Monopoly that night. All my belongings, all the keepsakes from my family and friends, all my books, food and furniture were gone.

I had to find a new place to live, but I also had work the next day. I was hesitant to take time off; I didn’t want to burden my colleagues. There was no emergency leave. If I missed my shifts, I would have to pay back everything I owed in time.

My mom, a physician herself, urged me to ask for backup coverage for a few shifts so that I could move before starting a demanding rotation in the intensive care unit.

Were it not for her, I would have worked straight through.

I stayed at a hotel until I found a furnished apartment in the same condominium complex, in a building unaffected by the fire. With just a few days to settle in, I only bought food, household items and necessary clothing. Rotating in the ICU, I didn’t need anything more than operating room scrubs to wear anyway. I appreciated not owning anything for a while, though I also feared buying anything, worried that I would lose that too. With the hectic schedule of residency, why would I invest precious free time buying things that could just disappear?

My colleagues were supportive. Some even offered me their homes. However, no one spoke to me about the impact of trauma or the importance of processing it. No one asked if I was able to sleep at night. No one asked if I had difficulty concentrating, or if I was frightened by what happened or at the possibility of losing someone I loved. No one offered counseling resources. The fire and all I had lost just became something to move on from.

The first day I returned to the emergency department, I was assigned to the same section and the same time of shift as when I was last there on the day of the fire. Initially, I didn’t think anything of it, but I was slow in caring for my patients. I was used to encountering the fragility of life at work, but the realities of impermanence and mortality in my personal life haunted me.

I couldn’t understand why it was taking me so long to do tasks I had done hundreds of times before — lab orders, image tests, speaking with consultants. My brain often froze. I was unable to make decisions, relax or recall the things I knew. Patients were frustrated. My attending was frustrated. All I could say was, “I’m sorry.”

Months later, I realized that this was how traumatic stress manifested itself. For all my years of training in emergency medicine as an art and science — in the ABCs of trauma resuscitation — I didn’t know how to process my own because I’d never been taught how to do it.

Would my career have been jeopardized if I took more than a few days off to process what had happened, sought counseling or did not complete the grant I was working on? Would I have seemed less dedicated as a physician to my colleagues? Or, would I have been better able to cope with what had happened if I allowed myself space to address it before long-term effects took hold? At the time, all I knew was that in the environment where I worked, addressing trauma was not only discouraged, but actively avoided.

“For all my years of training in emergency medicine as?an art and science — in the ABCs of trauma resuscitation — I didn't know how to process my own because I'd never been taught how to do it.”

Though the specifics of my story are unique, I’d later learn that experiences like mine were all too common among my colleagues in health care. Most prospective doctors are asked to make a lifelong commitment to medicine in the form of substantial medical school debt without knowing how the health care system really works. The prioritization of the financial bottom line, the outsize influence from pharmaceutical and insurance industries, and the lack of focus on health for both patients and providers are factors that feel far away. Once we become physicians, however, we may end up trapped in a sunk-cost fallacy; we become determined to make our careers work, placing our personal lives, loved ones and well-being last.

In the book “Mayo Clinic Strategies To Reduce Burnout,” Dr. Tait Shanafelt and Dr. Stephen Swensen write, “Many believe burnout to be the result of individual weakness when, in fact, burnout is primarily the result of health care systems that take emotionally healthy, altruistic people and methodically squeeze the vitality and passion out of them.”

A 2023 Medscape report on physician depression and burnout, which surveyed over 9,100 physicians across dozens of specialties, found that 53% described themselves as burned out. Burnout impacts patient care, with links to medical errors, a lower quality of care, longer recovery times and lower patient satisfaction. In the health care system overall, physician burnout is correlated with increased inefficiency, decreased access to care and increased costs — not to mention its detrimental impact on provider health.

Medical culture is also one that breeds stigma toward mental health. Health care providers face numerous barriers to seeking mental health care, including a lack of support, fear of negative career implications, associated costs and confidentiality concerns. The suicide rate of physicians is 1.41 times higher for male physicians and 2.27 times higher for female physicians compared with those in the general U.S. population, with an estimated 300 to 400 physicians dying by suicide each year.

The norm of health care providers functioning through trauma, burnout and unaddressed mental health issues needs to change. While hospital administration focuses on physician performance review metrics relating to operations, such as patients seen per hour, length of stays and procedures performed, it also needs to holistically assess provider well-being and proactively provide counseling and mental health resources. It must incorporate these elements into operational changes that will create a health care system that is optimal for both patients and providers.

In my own experience at the hospital, I tried to handle trauma like it was a normal occurrence — just a minor inconvenience. I carried on as if nothing else mattered. But plenty of other things mattered: my mental health, my relationships, my plans for the future. While it would take me years to fully acknowledge it, the fire made me a realize that my life was out of balance. There was no way forward on the path I had been on.

Five years later, after practicing as an emergency medicine attending, completing board certification and pursuing fellowship, I decided to leave traditional medicine.

The fire was the spark of change, a cleansing and purification. For me, like the phoenix, it was the beginning of a rebirth — a commitment to rise from the flames and build something new.

Jessica Singh, M.D., is a former emergency medicine physician who pursued the first one-year fellowship in physician wellness through the Department of Emergency Medicine at the Stanford University School of Medicine. She is the founder and CEO of Sukhayu Wellness and the Center for Health and Wellness Coaches, as well as a holistic coach and a consultant on health care provider well-being. She is passionate about facilitating environments to explore the root source of well-being and helping people enhance fulfillment in all aspects of life. Singh is also a fellow in the Public Voices Fellowship on Advancing the Rights of Women and Girls with The OpEd Project and Equality Now. Find more from her on LinkedIn.

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