Retired Central Texas ER Doc On How He Navigated The 'Painful Incongruity' Of His Work

May 28, 2019

Dr. Pat Crocker, a retired Central Texas emergency room doctor, says one of the struggles of his career was "trying to walk that line between empathy and self-harm." He says he wanted to maintain the human connection of medicine while not identifying too closely with patients' pain and tragedy.

How did he do it?

He actually doesn't have a great answer to that question. But after more than 30 years heading emergency rooms at Brackenridge Hospital, Children's Hospital of Austin and Dell Children's Medical Center, he has thought about it a lot.

"One of the things that I think helps is shaking the patient's hand, sitting down next to him and actually communicating face to face," Crocker says. "That allows you to establish some of that human link that makes you feel better about caring for some medical disaster or even a minor problem. But somehow you have to create an internal wall."

Crocker has compiled stories from his lengthy emergency medical career into the book Letters from the Pit: Stories of a Physician's Odyssey in Emergency Medicine."

He shares some of those stories – and some of the reasons he decided to step away full time from the profession he had wanted to do since he was little – with KUT.

This transcript has been edited lightly for clarity.

Dr. Pat Crocker: Very early on, according to my mother, I told her I wanted to be a physician. Somewhere along the line I became very interested in emergency medicine because it offered some excitement and a wide variety of patients. We treat everything – newborns, children, adults, fractures, trauma, heart attacks, strokes – and that seemed really appealing to me.

KUT: I want to read just a brief portion from the book and get your response. You wrote: 

“I came to my first realization that a career in the E.R. is not survivable without distancing yourself from your patients. If you feel too much empathy you also will become a casualty. I don't know how I feel about setting myself apart from my patients. I want to care for people. That's why I chose medicine. Now I've learned that I can't care about them too much. It's such a painful incongruity. How do you care for those you can't truly care about? Will I be able to walk this tightrope without faltering? I honestly don't know.”

I’d love to hear you describe how you walked that tightrope and how you navigated that tension.

Crocker: You need to feel some empathy for the patient or you lose the humanity of medicine. And I think it's really the human connection of medicine that makes it a happy and sustaining career. So you can't lose that. At the same time, you can't get too locked into your patient’s tragedy – whatever it is – otherwise, you too become a casualty because you identify with them and you know you feel their pain. Trying to walk that line sort of between empathy and self-harm was something that I had to struggle with at times.

KUT: How did you figure out how to walk that line? How did you yourself manage that?

Crocker: I'm not sure I have a great answer for that. One of the things that I think helps is shaking the patient's hand, sitting down next to him and actually communicating face to face. That allows you to establish some of that human link that makes you feel better about caring for some medical disaster or even a minor problem. But somehow you have to create an internal wall.

There's a story in the book about a young man who came in with a swollen arm, seemingly a minor problem. What I learned during the course of working him up and examining him and testing was that he had a very severe advanced cancer at a very young age. You're struggling with this connection you've established with the patient and the fact that you have to walk back into the room and tell him he may be dying. At the least, he's facing a major course of chemotherapy and a whole lot of care.

KUT: These are also patients – because it's an emergency room setting – you may never see again.

Crocker: That's one of the things that I've felt has been a failing for the emergency medicine physician – the lack of, sort of, knowing what happens. Ultimately, it's a career that's experienced in vignettes.

KUT: Can you tell us what for you was perhaps the toughest or the most challenging case that you ever encountered in any emergency room? Or just one that stood out for you in some way?

Crocker: One that stood out tremendously was a young man who was brought to the emergency department after a motor vehicle accident and in route developed cardiac arrest. We all thought, “All right, we're not going to get anywhere with this.” We still gave it our best shot and we resuscitated him and we still thought – 12 minutes CPR and blunt abdominal and head trauma - his future is probably bleak.

But he went off to the ER and got his operation. And I followed him along, and after about five days, I learned he was moved up to the floor, which meant he was off all life support, etc. And I talked to the doctor and he said he's actually doing quite well. I still remember going up to his room and peeking in the door. And here was this kid who had presented dead and he's watching TV and eating his breakfast.

Getting to be part of that sort of miracle is something that sticks with you.

KUT: What would you say to young people or med students who might want to do what you have done and be an emergency room physician?

Crocker: The possibility of having an incredible career doing what I think was the most fascinating job I could do is still possible. But I think they need to be aware that right now, the 2019 Medscape Survey of physicians showed that 48 percent of emergency physicians feel burned out, and only 4 percent were actually happy at work.

And to me that's tragic. For me, what kept me satisfied and gratified was that human connection. Let's face it, the rush of adrenaline is brief.  Adrenaline has a two-and-a-half-minute half-life, but the satisfaction from helping people is where the long-term gratification comes from.

KUT: How did you know that it was time to stop?

Crocker: Once one of my older friends retired – a very busy trauma surgeon whose practice I admired – had retired, I called him and said, "You know, hey, how did you know it was time?" And he said essentially, "Don't worry; you'll just know."

And, you know, one day I got up and it wasn't quite as much fun as it used to be. And there's a growing burden of computer work paperwork generation; all sorts of things that have been thrust onto the physician now and that's very different from when I started. And those things are really not very satisfying to do. And I think that it leads to more dissatisfaction.

Finally, I decided, I've been the guy in the ER waiting for the disaster for 37 years now and that was enough.

Hear the extended interview: