Tales from “The Pit”

When I showed up in the ER for my first shift as an emergency physician, the American Board of Medical Specialties had not yet recognized emergency medicine as a bona fide clinical discipline. In those days, physicians often referred to the ER as “The Pit.” To maintain medical staff privileges, doctors had to take their turns in The Pit—whether they had any knowledge or recent experience in handling medical emergencies.

Hospitals assumed that anyone who graduated from medical school had that knowledge. Wrong. Think about the patient suffering a heart attack brought to an ER staffed by a psychiatrist ten or more years out of medical school. No offense to psychiatrists. I respect psychiatry and those who practice it; but when you suffer a heart attack, you need a doctor who treats them every day.

The patient-centered specialty of emergency medicine began when a cadre of dedicated physicians chose to practice full time in The Pit, often suffering insults from their more traditional colleagues. The perseverance of these early pioneers resulted in a highly valued and respected medical specialty that now draws from among the best and brightest medical school graduates.

When I resigned a residency in neurosurgery and climbed aboard the ER train, the future of the emergency medicine specialty was still a distant vision. “Worth a shot,” I thought. I never looked back.

Stay tuned for future posts that will describe some of my experiences in emergency medicine, including some “pearls” about what to do if you suffer a medical emergency.