Why I’m Still Here

— A ROSC Year-End Review

Dec 30, 2025

A note to newer readers:
When I first published this piece, this community was about 500 people smaller. Over the past year, many of you have joined—often through stories that zoomed in on a single moment, a single case, or a single fracture in the system.

This essay is different.

It’s a wide-angle lens—a synthesis of the themes I keep circling back to. If you’re new here, this is a good map of the territory. If you’ve been reading for a while, you’ll recognize the scars.

Throughout the piece, I’ve added links to essays that expand on these ideas for those who want to go deeper.

Over a decade and a half into my journey as an emergency medicine physician, I find myself reflecting not just on the cases I’ve seen, but on the evolution of who I’ve become. This field is unrelenting—demanding unwavering focus, emotional resilience, and a relentless commitment to care. Every shift is a new story. Every patient, a new puzzle. There are soaring moments of triumph, and there are nights when loss weighs so heavily that you feel it in your bones.

We’re often called the “gatekeepers” of the hospital. But that title falls short. We’re not gatekeepers—we’re gate-openers. We advocate fiercely for our patients, often in their most vulnerable moments. We operate at the intersection of urgency and compassion, making decisions that can change—sometimes save—a life. That responsibility is profound. And the privilege of being that advocate never gets old.

But this path isn’t for everyone.

Emergency medicine will burn you out if you don’t have the fire to begin with. The ones who stay—the ones who thrive—aren’t just tough. They’re passionate. They’ve learned how to cope. They find meaning in the chaos. They laugh at the absurdities. They cry when no one is watching. And they get back up the next day to do it all over again.

Throughout my training, I encountered cases that carved deep grooves into my memory. Traumatic resuscitations, senseless tragedies, losses I’ll never forget. But those cases were also my teachers. They showed me how to be resilient—and how to lean on others. In emergency medicine, no one does this alone. We learn from one another, pass down our scars and lessons, and over time, we develop something more than knowledge. We build gestalt—that hard-won clinical intuition that only comes from years of doing the work.

That wisdom isn’t just about medicine—it’s about people.

I’ve practiced on tarmacs and in tents. In disaster zones and crowded trauma bays. Humanitarian medicine reminds me what matters most: gratitude, connection, purpose. But it also prepares us for the high-acuity, low-occurrence events—the moments when everything is on the line and there is no script. Skill matters. But so does calm. So does conviction.

One of the hardest parts of this job is delivering devastating news to families. You can’t rehearse it. No training prepares you for the look in a parent’s eyes when you tell them their child didn’t make it. Those conversations haunt you. They change you. You carry them with you, tucked between your ribs.

What helps us survive? The people beside us. Nurses, respiratory therapists, paramedics, clerks. There’s a sacred camaraderie in the ED. Tensions flare, sure. But when trauma rolls in, we move as one. The bonds forged in those moments are unshakeable.

And yes—there’s humour. Dark, inappropriate, cathartic humour. It’s how we stay sane.

At our core, emergency physicians are generalists with a specialist’s edge. We don’t wear pristine white coats. We wear scrubs stained with blood, coffee, and adrenaline. We are the Swiss Army knives of medicine—decisive, adaptable, always ready. And yet, beneath the steel, we must preserve empathy. Communication. Humanity. These are not “soft skills.” They are essential.

Many of our patients don’t come with clear-cut diagnoses. They come with fear. Trauma. Chronic pain. Psychiatric suffering. Functional complaints that test our patience—and our compassion. But everyone has a story. And it’s our job to listen, even if we can’t always fix.

We don’t always get answers. That’s one of the hardest truths about this field. But sometimes we get moments—glimpses of healing, flashes of clarity, the simple satisfaction of making someone feel heard. Sometimes, stabilizing a patient without solving the entire mystery is enough.

As I look back on the last fifteen years, I feel a deep gratitude—for the patients, for my colleagues, for the path. This job has broken me down and built me up in equal measure. It’s not just a profession. It’s a calling. A crucible. A privilege.

And I’m not done yet.

If you’re new here: this piece is a map of what I keep writing toward.
If you’ve been here a while: which of these themes followed you home this year?