Fourth Place: Jeffrey D. Lazar, MD

"Home is the place where, when you have to go there, They have to take you in." - Robert Frost, The Death of the Hired Man

My patient, I was quick to learn, was a billionaire who’d invented and popularized a household food item. He’d presented to our ED with somewhat concerning chest pain. One stretcher over from him was another chest pain patient: he was one of our regulars: homeless, addicted to alcohol, with a laundry list of poorly managed diseases. These two men's fortunes could hardly have been more divergent. And yet, there they were lying on identical stretchers, and the orders placed on both patients happened to be identical.

In my decade of practice as an Emergency Physician, it feels as if there’s no segment of society I haven’t touched.

I’ve delivered infants into our world, and provided comfort to patients preparing to exit it. I’ve delivered good news and helped my patients smile; and I’ve had to deliver life-shattering news that left my patients and me in tears. I’ve watched full lives end naturally, and young lives that ended prematurely. I’ve had the pleasure of looking at radiologic studies and reporting them as normal, and shared the misery of discovering findings no one would anticipate. I’ve pulled things out of places, put things back into places. There are many wounds I’ve closed, and others I’ve had to open.

There’s the tension pneumothorax I decompressed that once restarted a stopped heart, and other memorable cases where a combination of skill and fortune helped me make a key diagnosis quickly. And there are also the cases that in hindsight I’d wished I'd done something differently, or recognized a missed sign or symptom, and that left me beating myself up.

I’ve had shifts that easily confirmed I have what is simply the greatest job in the world, and shifts that have left me wishing I’d chosen another path in life.

Lately, when I’ve given my orientation and welcome to talk to our interns, I display a slide with the above line from Robert Frost’s poem, and I tell our young new doctors: when a family doesn’t know what to do with their grandmother who’s increasingly agitated; or a young parent isn’t sure about their infant’s continuous crying; when society doesn’t know what to do with one of our fellow human beings who is lost and confused, their answer will be to bring them to the Emergency Department. Where other agencies might not wish to assume the risks that accompany the act of assisting individuals in all forms of extremis, we routinely accept it as part of our mission and our duty.

I see Emergency Medicine as not only an art and a science, but to paraphrase another great American poet, Wendell Berry, a grace that keeps this world.