The Peephole


When people learn I work in the emergency department they usually ask, “How do you do it?” Or they say, “Wow, I bet you see a lot of crazy things.” My answer aloud: “It’s never dull.” My answer in my head: “You have no idea.”

In Your Own Words


When people learn I work in the emergency department they usually ask, “How do you do it?” Or they say, “Wow, I bet you see a lot of crazy things.” My answer aloud: “It’s never dull.” My answer in my head: “You have no idea.”

In what other profession do you walk out of a room where someone has just yelled, “I’m gonna kill you, Bitch!” and laugh? Where else do you preform CPR, call a time of death, then talk about your weekend plans all in the same breath? It gets even worse.

Even the worst ones – a rape or a case of child abuse – have to be walked away from and on to the next stomach ache, cough/cold or heart attack. It may, for a minute, leave a pit in your stomach the weight of bowling ball. But even then, you can usually get rid of it with a sigh so deep that it goes all the way down to your toes. Sometimes it takes two sighs.


Sometimes I give a high five to someone on my team. Not to say “congrats,” but to feel a little human touch and know I’m not alone.

If a tear feels like it might try to work its way up from your throat, you swallow it quick. It does no one any good to let it out. The family can’t see it. Your co-workers can’t see it. We all get one turn to break down and then everyone else has to be strong. But we can’t all walk around like sobbing messes. When I see another on my team tear up (children who have died is often the cause) I know this time it can’t be my turn.

So we suck it up. We learn to turn “it” off. Too well, in fact. What choice do we have? We cope. We walk into fatal car accidents with our first thoughts (mentally, at least) being, ”were they drinking, were they high, they probably weren’t wearing their seat belts.” Something, ANYTHING, to separate us from this. Something, ANYTHING, so we can sleep at night and try to convince ourselves that we are not so temporary. That our spouses and our children are not so temporary.

When we can’t find reasons, we have no choice but to swallow that lump. We come home, we hug our kids, and we cope. By the time we wake up for our next shift, the lump is almost gone.


Each time I’ve had to do that, I’ve lost a little something. I shut off a pathway to sadness, remorse or fear so many times that now those feelings are hard to come by at all.

But I’m not alone. And it’s the people by my side who make me feel normal about this chaos that we live in. This peephole into reality that only a few of us see. We, more than anyone, understand the temporary nature of it all. The unfairness of it all. That even children aren’t safe from this awful game of life that, no matter what, ALWAYS ends in death. What choice do we have? This is our job. This is our life. Even if we quit, it’s too late. Once you peep through that hole you can never pretend you haven’t seen it.

If you don’t live in our world then that last sentence is morbid – creepy even. But in our world, it is fact. It is life. It is truth. We have no veil of ignorance when it comes to our own mortality. Much to the dismay of our family and friends we sometimes come off as “cold” and (I hate this one)…”insensitive.”
So we may cry a little less. But here is the upside: we also gain a new ability to laugh. To love fully. To live without regret. We generally don’t waste time on negativity or pessimism. We understand fully “one life” and we aren’t about to waste it. We wear our seat belts and don’t drink and drive. We live smart, but never in moderation! We don’t shelter our kids, because even children without trampolines are sometimes “temporary.” So we let them jump and we let them laugh, we just have a net! We don’t keep them home from the park because we are worried about the “Bogeyman,” because we know most of the time it’s “Creepy Uncle Ralph” who is causing the trouble.

If I did this job alone, the isolation would drive me insane. But I don’t. My co-workers are my sanity. My family: my rock. Together we get through this life with our eyes wide open.


  1. Beautifully said. After 30+ years in this business I found that few people in the world understand life as we do. That is why many of us are only completely at ease with our coworkers. It is in many respects like the military. Ask Mark Plaster.

  2. Great piece Heather! I always knew you had a human side 🙂 Don’t let the harshness of reality chink away at your humanity armor

  3. Jennifer Pasztor on

    I am truly blessed to have you as my coworker, we all are. You are an amazing person and we would be less without you. Thanks for writing this for the many that think it but just don’t say it. You have captured our world.

  4. Mike Abernethy on

    As a former EMT and PGY 25 -Ive been in the game for quite awhile. One of the best descriptions of our work I have read. You mirror the literary caliber of Ed Leap.

  5. This is such a great piece. I have had family and friends ask me how I can deal with so much craziness, death, destruction, have people curse at me but return the next day to do it all over again. My answer has all ways been because I love what I do, but I have worried that I have become numb and jaded. Thanks for letting me know I am none of the above, and also not alone.


  7. Well said! I wrote a similar essay once about a trauma patient and posted it online. I got some great comments but found it amazing how many comments I got like “wow, now I see that ER nurses really do care” and “nice to know you guys do have feelings underneath all the bad jokes.” I never realized until then (I was relatively new at nursing then) how we were viewed by other disciplines. The ability to laugh in the midst of it all is priceless and the only way to survive our job.

  8. a sister of a peer on

    You never know how it feels to lose a loved one until it happens. Cherish those who you love always. Life can be bitter unless you embrace it. Speaking from experience it. I loved reading your article, my brother is in your same shoes and I can’t imagine what a day in the life of my bro looks like but at the end of the day I know he is making a difference in someone’s life. That is more than I can say for most and I have the at most respect for him and any like him. Love you Buddy.

  9. Thankyou. that was well said I have worked in our ED for 12 years. And you said it for me and also helped me to understand my attitude about life. I do love fully, I am very passionate with my emotions. I dont worry about convention.. what I should or should not do.. I do want I want and enjoy it to the fullest. I love being at the bedside taking care of patients from all walks of life. Sometimes I cry other times I support a teammate that is sad. Sometimes I am compassionate but not always. Being an ED Nurse has helped me learm who I am and really enjoy being me..


  10. i have been on both sides. first as a medical assisstant, emt, and registered nurse,,, then the big one a patient…i have multiple sclerosis…and have experienced many hospitalizations and trips to the er…all i can say is well said i love your outlooked and agree 100 percent, however, as a patient, the care that i recieve is usually 90 percent of the time below the level of care i would even consider giving one of my former patients..i appreciate the difficulties of the job, the stress, long hours, lack of appreciation…But please dont take it out on chronically ill people. that is a whole different catagory in the er facilty..we are treated soooo different..but our pain and deperation for relief is no different than an acutely ill patient……

  11. A nice job characterizing how I feel about my work over the last 34 years in the ED and how It has affected me. Thanks for writing this. AB

  12. Thank you for this thoughtful and moving piece shared by an old friend who is an ER physician in a major metropolitan trauma center. I want only to point out one thing– as the mother of a 17-month-old little girl who died not upon arrival in the ER, but in the ICU not long after from an aggressive case of bacterial meningitis, I live on the other side of the peephole. While I am very grateful not to have to look through it all the time to see all the other awful realities that could face my loved ones at any point, I would give anything to be on your side of the peephole instead of mine. Please don’t take this as a criticism, as I am absolutely certain that you take exquisite care of the children and their parents who, most horrifically, find themselves in your charge. And I deeply respect and admire ER physicians (I was just in the ER today with my husband who ended up having kidney stones, but I was in awe of the calm the young ER resident exuded as my husband was basically screaming in pain in her face). It’s just that when I read your statement, “We, more than anyone, understand the temporary nature of it all. The unfairness of it all. That even children aren’t safe from this awful game of life that, no matter what, ALWAYS ends in death,” my first thought was, “Well, actually, no, you don’t know better than all those families on the other side of the peephole, all the families of those who died.” Because you see, we don’t have the luxury of turning it off. I don’t get to go home and be grateful that my daughter is still alive. Again, I respect and admire you for sharing this vulnerability with your colleagues and the world. I just thought you might be interested in hearing from the perspective of someone who must forever live on the other side of this. Thank you so much for what you do.

  13. Dear turtlemama…loved your response, don’t forget this though…. How do you know that none of us live on the ‘other side’ …..some do, and some still continue to give….we all have stories, we all have lives. Just because some work in the medical/healthcare field does not not make us immune to sadness, loneliness and forever remembering a loved one.. It is our job to do …just as any ones job is ‘to do’.

  14. Dr Carone wrote an awesome article of what many of us do day in and day. I Also feel that many of us forget that we are doctors by choice and that it is a great honor and resposibility to respond to the call of the sick. Having said that , it breaks my heart reading turtlemama observation of those residents ignoring her husband in pain. I hope htey read this article

  15. Heather Carone on

    Thank you so much for the positive responses. I’ve always written but have never shown my writing to anyone…more or less published it 🙂

    To turtlemama: I have said to my husband (who is not in health care) a dozen times that there is nothing more agonizing and painful and bone chilling than the howl of a mother that has just been told her child is dead. I mourn for the child, of course. But, The death of the child is only half the pain we feel. The look on the parents face when we have to tell them their child in gone is the second half.. Simply heart wrenching. It’s hard not to run out of the room! It’s hard to keep looking them in the eye…It’s hard not to vomit. Of course it’s not as hard as losing my own child but it really really freaking sucks. (Cant think of better words). Most ED docs will go through this scenario hundreds of times before we retire. It’s probably the death of children that makes us immune to everything else. After you have seen the death of a perfectly amazing innocent soft sweet child…what could be worse? It’s not that our pain is greater. It’s not even close. iIt is just that we have to do it over and over and over. So to you, turtle momma, I’m truly sorry for the loss of your baby. I have 4 of my own and imagine that every day must be a challenge for you. I’m sorry if my writing implied anything less.

    To disabled nurse: I also often say…I’d pick a average intelligent resident who has compassion over a brilliant one who has none. After 3 years of training we can make (almost) anyone a well trained, competent Emergency Physician. It is much harder, sometimes impossible, to teach compassion. it is amazing how many young docs have never had pain. When I hear…”whenever I get (insert painful condition here) I just take a Tylenol” I want to rip my ears off. As if somehow they would know what is like to have someone else’s pain.. The same docs (and nurses too) roll their eyes at patients with an addiction or those that couldn’t afford their medications but bought cigarettes… It’s a general inability to put themselves in someone else’s shoes. Empathy. I try to teach it everyday. It is especially easy when I have a resident to my right feeling sorry for the 4 year old in room 10 covered in cigarette burns while the resident to my left complains about the belligerent drunk 18 year old in room 11 in police custody. Connect these two dots my friends! Why do we lose compassion when that child turns 18. We all come from different places..walk a mile in someone else’s shoes… Empathy empathy empathy! So…I try to always set a good example and keep preaching. Most of the trainees just need to be taught these lessons just as they are the taught the lessons of STEMI management. And luckily, most of them eventually get it, even if they didn’t come with it. My inability to “turn things off” only has to kick in when the show must go on. Like Dr Crespo said…it is an honor to be called to take care of the sick. It is one I truly cherish.

  16. J., thank you for your response, and I absolutely understand exactly what you are saying. In fact, one of the first bereaved parents I met in a support group was an ER doctor in the same children’s hospital where my daughter died. Her 20-year-old son had been killed in a motorcycle accident. I could barely believe that she was able to go on dealing with parents in the middle of their worst nightmare, a nightmare she had already experienced herself. I only responded as I did based on Dr. Carone’s experience, which did not seem to encompass a significant loss.

    Also, I just want to clarify that I had no problems at all with my husband’s treatment in the ER– I was incredibly impressed with how well the resident handled herself given the situation she was facing with my husband screaming in pain.

  17. Fantastic Article, thanks. My company provides services to ED’s across the country, and I have always loved the dedication, toughness, and ferocity of the ED community. You see it all, and make an enormous number of decisions every day…some small, and some very BIG. I believe this article has done the best job I have seen describing the true character and compassion of most ED doctors and nurses. THank you for validating why I love to work with ED’s.

  18. Gregory Hayes on

    Well written. As a one who works in an ER this article nails it! Just when you think you’ve seen it all, you end up seeing more. Working in an ER is nothing like any TV show that has ever or currently existed. I am ever so thankful for my ER family, we tend to stick together as were are the ‘redheaded step children’ of any hospital.

    I have heard others (who have never worked in an ER) say “I understand what how it is there.” That is just plain crap. For those who have never worked in EMS, the ER and ICU cannot understand what happens there. One minute we are trying to save a life, the next were are spat on or told we don’t know what we are doing (and you wonder where some people get their medical knowledge.)

    Yes it does take a special person to work in an ER, I have seen RN’s from general med floors run away and say that we (those that work there) are crazy, and that may just be true. I have seen doctors (residents) who couldn’t handle it. For them it was a case of not ‘having control’ as many times the staff (RN’s, techs) are doing things before they can react. Yet, I am ever so grateful for the medical providers I work with, who see me as a vital part of the team, who listen to what I say and respect me and value my input on the care of people who come to us.

  19. Usually I am not regular to read article on blogs, but I would like to say that this write-up very pressured me to check out and do it! Your writing taste has been surprised me. Thank you, quite nice article.

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