Emergency Medicine Collective Wisdom: Jenny Beck-Esmay

Author: Jenny Beck-Esmay, MD (Co-Director, Medical Student Clerkship, St Luke’s-Mt Sinai West; Editor-In-Chief, FemInEM.org; Co-Host, CoreEM Podcast) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

My first experiences with emergency medicine were as a pre-medical student shadowing and volunteering in several emergency departments.  I was immediately drawn to the vast array of medical problems and wide variety of issues dealt with by the physicians.  They seemed to be able to do anything and everything! And on top of it all, they really seemed happy and to enjoy the work they were doing.  While I can’t say I am happy during every moment of every day at work, I truly love my job. I still love the variety and keep-you-on-your-toes nature of the ED. But it turns out that is not as important to me daily as how much I love being with patients in their time of need.  Regardless of the frustrations of any given shift, I can almost always look back at the day and identify at least one person for whom I made a difference (and usually a lot more). That is incredibly satisfying.  It’s an honor what we are allowed to do and remembering that keeps me grounded and loving our field.

2) Most impactful case

The most impactful case for me was one of a good death.  An elderly woman was brought in by EMS after being found in her apartment by the doorman or super. She clearly had been in bed for several days, was likely septic and dehydrated, but not terribly unstable at presentation.  She wasn’t entirely oriented, but she made it clear to us that she didn’t want things like straight caths etc by fighting nursing ferociously; she was incredibly strong. We were able to get in touch with her next of kin who told us over the phone he didn’t think she would want much done and was able to come to the department within a few hours with her MOLST form stating what she would and wouldn’t want done.  I was able to have a thorough end-of-life conversation with the family, and together we decided doing invasive things to her would be unlikely to change her outcome and that we would have to sedate her to even get those things done, which didn’t seem like something she would want. We decided focusing on her comfort was best.  She died within the next day or so, comfortably and with her family beside her.  I hadn’t done much of anything medically for her.  If I recall, I had her on BiPAP for a while because she was breathing uncomfortably and gave her some fluids. Her family found me in the department the next day to thank me for caring for her. They were so grateful for how we were able to keep her comfortable and dignified at the end. I think about her and her family often when I get similar cases. It was a lucky scenario where all the proper pieces were in line to get her the care she actually wanted. I wish every similar case could go as well.

3) Most important career decision leading to satisfaction

It feels cheesy to say this within a FOAM forum, but the most important decision I made was to get involved in the FOAM community.  For that I have to thank my mentor, Anand Swaminathan.  His love of blogs, podcasts and innovative medical education infected me during my residency. I was able to get involved writing for a few blogs and then took to podcasting as well. Working on this medical content is the single greatest way I have learned to study for our field.  Asking a question, researching, and then creating the content makes me really learn the material.  I know I am a better doctor for it.  In addition to making me medically better, the FOAMers I have worked with have become some of my greatest friends. Along with community that has been created among the women (and men) at FemInEM, I have found the people who keep me hungry to learn and to stay in the game.

4) What does future of EM look like?

I think the future of EM will include more and more technology.  This will obviously be true across medicine, but I think what it will mean for our field is that more will be expected of the emergency department.  Take ultrasound as an example.  As we figured out more that can be done with ultrasound and developed better and more portable machines, more was expected of the emergency physician.  I have no idea what this will look like (when the first iphone came out, I couldn’t understand why one would possibly want their music on the same device as their phone, how short sighted!). But I think as things can be done more efficiently, more that was done as inpatient medicine will be done in the ED and/or ED observation type units.

5) Greatest achievement / why giving back is important

I think when you love something you share it.  At least for me, this is how my love for something grows.  If I read a book I enjoy, I want all my friends to read it.  I enjoy it even more when I can talk about it with them.  When it comes to our profession, this sharing takes the form of teaching, and not just our medical students and residents.  The importance of that is probably obvious to all of us in the FOAM community.  Sharing our knowledge with school students through health education outreach programs gives them a better chance at a healthy life.  It builds health literacy which will make them better patients.  And maybe it will instill an interest in medicine as a career or at least an appreciation for what we, as doctors, are trying to do for them. Sharing our knowledge with patients and families in the department helps build a trusting relationship and empowers them to take control over their own health, something we all want!

6) Favorite failure

Before medical school I studied musical theatre and spent some time tending bar and auditioning/performing in New York.  I think the best thing that happened was that I failed to be a successful actress.  I quickly became disillusioned with the process and stopped having fun doing it. When I started to dread a phone call from my agent because it would mean an audition for a job I maybe didn’t even want, I realized I had to do something else.  I then went back to school for my pre-med courses and made my way to where I am today.  I feel sad sometimes thinking about what my life would be like if I had stuck through that process.  I feel particularly sad when I watch brilliant, beautiful theatre and wish I was creating it.  But having studied theatre impacts my practice of medicine, and I am so happy and lucky to be doing what I’m doing now, that I wouldn’t change that failure for anything.

7) One thing you would change about our field

One of my greatest frustrations in our field is the inability to get patients the proper follow up and social support they need.  Recently I had a patient in the department for the third time this month for poor asthma control.  She knew she needed her Advair, but it costs $400.  And on top of that, she couldn’t get in to see her primary care doctor for the next two months.  Another day I had a patient in the department with hyperglycemia because he couldn’t take his insulin.  He had the pens but his doctor forgot to prescribe the needles.  I didn’t even know you had to prescribe the needles in addition to the pens.  Again, he couldn’t get in to see his primary for several days and ended up in the department needing DKA rule out.  I would love a system where arranging close PMD follow up was simple and where patients could get and afford their medications!!

8) Something that you love that has indirectly impacted your EM career

I am a great lover of fiction, and I am a great believer that reading fiction helps to develop empathy in the reader.  Fiction puts the reader in situations outside her reality, it makes her think about or challenge stereotypes and think about another person’s feelings and motivations. I hope that practicing these skills through reading allows me to better understand and interact with my patients who come to the department from all walks of life.  On a less lofty note, I am happier when I’m reading books.  I note a direct correlation between my sense of well-being and my ability to find time to read. I’m a better doctor when I’m happy, therefore I’m a better doctor when I read!

3 people you’d like to see fill this out:

1) Swami

2) Dan Egan

3) Vic Brazil