Depressing week in the ED

There were a disproportionately high number of horrible cases that I've seen in the past week...to the point where even the attendings were getting a bit down.

• It started with the 18 yo girl who fell while riding her bike without a helmet and had multiple depressed skull fractures. When I left that night she was in rough shape, but I never actually found out what happened to her.
  
• Two days ago a 47 year old woman came in who had collapsed at home after the worst headache of her life. She died while she was in the OR having her dual ruptured aneurysms clipped. She left behind her 4 year old daughter and a teenage son
  
• Then there was a 41 year old woman that had an MI that died (I wasn't there for that one).
  
• And last night, there was a healthy 36 year old man that collapsed while playing hockey. He was stabilized and sent up to the cath lab, which showed a 100% occlusion of his LEV. 2 stents were placed and the guy appeared stable after a few hours in the CCU. Then about 3AM we heard the code called overhead, and found out shortly afterward that he didn't make it. He left behind a 4 month pregnant wife, and both of his parents.
  

Now, I'm not one of those med students that was planning on spending half of his career in aclinic in Sudan ridding the continent of AIDS, but I'm finding that I still have a sliver of the starry-eyed optimist that I once was. It's mostly because I'm not all that far removed from my own pre-med misconception of medicine as a land of sunshine and puppy dogs. I go into the ED most shifts expecting the majority of the patients that come through the doors to leave happily or healthily, or at least to be somewhat cordial to us since we are refilling their narcotic stash and pumping them full of opiates. However, I've gotten a cold dose of reality over the past few shifts: not everyone gets better, people die, people lie and some really crazy shit happens in the ED (including a guy apparently threatening to go home and return with his pistol because he was "mistreated" before he walked out the door).

The sad part of it all is, that medical admission committees expect us to be deluded in our interviews and applications. They want us to paint our own grandiose pictures of serving the under served and curing sick patients who are always compliant. Meanwhile, the majority of us have no idea what we were getting into, and walk into the hospital to have our sunny dispositions squelched by hostile or non-compliant or really sick patients that not very much can be done for.