In my end is my beginning...

Epilogue. i began writing this on the cusp of my last shift. i thought ahead about the last time i would walk across the glass bridge and through the doors of our bustling ER...the place i've considered 'home' over the last few years. I dwelt on the loss of something that has been both comfortable, and anxiety-provoking at the same time. The last few months had been a hard stretch. But we had continued to serve the community without faltering. Now, as i stand to lose this familiar place, I steel myself to leave behind so many friends. Yet, as I prepare to walk away, I pledge to carry the lessons of our collective experience with me...

I fumbled my way into the ER for the last time taking notice of all the details that you miss in a comfortable life. I gauged the heaviness of the door at the top of parking deck staircase. I counted the paces across the glass bridge. As I wound my way into the back of the ER I noticed with new interest the scuff marks from stretchers that had tattooed bare white walls. I grabbed my stool in the physicians' workspace and spun around one last time.

The night began with weakness, dizziness, nausea & vomiting in pregnancy, and a ground level fall. These first four were easy. After that, I started to think about how these may be the last patients I would see here. I listened to a man tell me that he felt hot. That his insides were on fire and his bones were melting. I listened with great interest to people with chest and abdominal pains. I marveled at the clumsiness of an obviously intoxicated, lethargic woman I had seen a few nights before who had fallen from a ladder. Now she reported she had fallen while hanging some curtains. She was here for more pain meds. But only the Lortab 10s... The night wore on. I saw a mountain of a man with intractable headaches and fevers. I grabbed a bedsheet and my hands instinctively began drawing my spine diagram... to explain the last lumbar puncture I would perform in these cramped rooms. I admitted a girl with pseudoseizures and tried desperately to convince another woman that a bluish tinge in her lips was not the sign of a life threatening illness. Eventually I had to discharge her despite her misgivings... The night ended with a plain woman who had eaten a bad watermelon. That was it. The last shift...

I made rounds through the ER several times trying catch everyone who had been part of our family over the last few years. Clerical partners, environmental services, hospitalists, monitor technicians, secretaries, medical records personnel, nurses, respiratory techs, administrators... the ER is a living, breathing quilt. Hushed goodbyes. A few hugs. A card that made me and my throat catch. I walked passed some of the new physicians and administration that had taken over our operations. It was hard to see the new faces that were part of the ED's restructuring... like meeting the new spouse of an ex... still, as one my partners said, the one thing you can count on in life, is change.

In the days ahead i move to a new madness. A long and windy road to a new hospital, a new group of colleagues, and new patients to serve. As I look forward to busy weeks of memorizing passwords, remembering faces, and learning the terrain of a new department, I will cherish my old colleagues and the life lessons we've shared, the plague & pain we've fought, and the doctorin' we've done...

it's true. the medicine is the easy part.
it's the humanity in medicine, that makes it so incredibly hard,
and yet so incredibly rewarding...