Twenty years in Maine’s emergency departments

Posted Sept. 21, 2009, at 5:31 p.m.

“Twenty years now, where’d they go? Twenty years now, I don’t know. Sit and wonder sometimes — where they’ve gone.” — from “Like a Rock” by Bob Seger

It’s not often I get to walk down an emergency department hallway with blood on my hands and a smile on my face. But then, it’s not often I get to deliver a healthy baby in that hallway, on an ambulance stretcher, to a mom headed for the hospitals’ obstetrical unit. That baby just could not wait that night a few weeks ago; there was no time for gloves, no time for privacy, and no time for proper introductions. If that mom and I ran into each other tomorrow I bet neither of us would recognize the other, even though for about two minutes we were very, very close.

That’s life in Maine’s emergency departments, or ED, where, as of this month, I have been working as an itinerant doctor for 20 years. Twenty years — about 788 million beats of my heart that have just flown by, sometimes pounding and sometimes in my throat, always reminded by my work that one heartbeat is no guarantee of the next. In those years I have worked in 17 of Maine’s 36 hospitals, from Boothbay Harbor in the south to Limestone in the north, from Farmington in the west to Machias in the east.

I started working in EDs for the extra money. As a resident in my training I had a family to feed and $125,000 in debt to pay off. I keep working there because I love the work, the patients and the people I work with. The latter are some of the finest I have ever met, a collection of people weird and wonderful enough to work at night in small EDs where anything can roll in the door and often does, where no one ever gets turned away and where miracles happen just enough to keep us all hooked.

The first ED I worked was Redington Fairview General Hospital in Skowhegan. Late each summer there, ED docs start seeing high school football players coming in injured and football spirit start taking over the town. There you also see the retired shoe shop workers from its closed mills, the ones who still remember when America walked in Maine shoes. In the young players with banged up limbs and in the old workers with their gnarled working hands, you see generation after generation of the “salt” of Maine’s earth.

I worked at Loring Air Force Base’s hospital during the first Gulf War. There I saw U.S. Air Force bomber crew families made sick by the anxiety of knowing loved ones were flying bomb-laden B-52s from Diego Garcia off the African coast 10 hours up to the missile-streaked skies of Iraq. They all made me realize how much some sacrifice so that others might live in peace.

At Penobscot Bay Medical Center in Rockport you see captains of industry visiting Camden on vacation and captains of lobster boats visiting the ED under duress (“My wife made me come in, Doc”). These two different rungs of the social ladder may look different walking around, but sick and afraid, they are a reminder that emergent illness is a great equalizer. With pink froth foaming up your windpipe from fluid-filled lungs, gasping for air and life, we are all basically the same, no matter what we captain.

I spent a different 20 years being educated in nine different schools, but learned more of the important stuff in the ED than I ever did in the classroom. The ED taught me how to shut things off; my mouth, my expectations, my emotions and my view of the world, all so I could see the patient in front of me without bias. I learned there that not everything I think is worth sharing, that great teams are always better than great stars and much more. When I remember all of this I am a better husband and father at home, a better hospital CEO at work and a better person.

Best of all, I learned that to know and love working in Maine’s EDs is to know and love Maine and its people, and I do.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.

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