People don't know you.

No, I don't know.

He doesn't have any family.

Here you are like the magic didn't work this time.

We were too late to make a difference.

It happens sometimes.

Someone we don't even know.

Perhaps don't even want to know Will touch us.

Will make us think will break through a shell 88 a year on Father.

I think about this sometime.

See him come to you like this about my day.

When something does get through, a lot of us tend to push it down, block it out.

Try and carry on without work way.

Tell ourselves it doesn't get to us.

But it does.

Death can be a powerful stressor.

But then there's no lack of stress And what we do.

Sometimes we can feel inspired by our own power because we save lives.

And sometimes we can be demoralized by our own powerlessness.

Because we don't save lives, we lose lives.

This is Dr Frank up.

Berg, a psychiatrist, a consultant here in Detroit, receiving on a professor at Michigan State University.

He knows a lot about the emotional impact of stress and trauma on victim and care giver like burnout is a chronic condition, or at least it's caused by having been placed in a situation of often of relentless responsibility.

And is, there are certain institutions in which people seem to have more of this.

People who are prison workers, people who work in school systems, people who work in hospitals.

We've all felt the pressure of that responsibility, whether we're fresh out of school or veterans back.

Dr.

Sweeney.

He's vice chief of emergency medicine at Detroit receiving hospital, and he has the overnight shift tonight.

He's been up all day, and he knows it's going to be a long 12 hours before he gets to go home again.

I have been there yet.

There's a door we walked right here.

Well, it will be able to tell.

It's It's barely 6 30 on Friday night, and the emergency department modules are already filling up at a few codes.

A few complicated cases and the adrenaline can really start pumping.

It may help make the night go faster, but can leave you exhausted by morning.

Dr.

Sweeney's been on the front line long enough to have learned to deal with the pressure and to have helped some of the rest of us do the same.

I think he starts a shift with the briefing.

I already had it, but it doesn't bump.

Thes cases are all his responsibility now, at least till morning.

Thing has to stay.

So this is what's cool.

To be normal for him.

Yeah, but on this party and he actually had our way.

Pace could be real.

Agnes.

So can the responsibility away those decisions.

Big decisions which affect our patient.

When it gets too much for too long, the result can be burnout.

We all know the symptoms so we don't talk about it Much.

Feelings of helplessness, demoralization, avoidance, depression, exhaustion, difficulty sleeping headaches, loss of appetite.

Does it mean were burnt out?

Not necessarily.

Burnout is a cumulative process, one we only need worry about if the symptoms become chronic and start to interfere with our work and our home life.

It may look quiet here outside the operating room, but that's deceptive.

It doesn't get noisy and crowded, like in the emergency department on a busy night on it doesn't get his intimate.

As in the critical care units upstairs.

Somehow it seems a little more focused more clinical, more controlled theme with Pressure's just is intense, just Israel.

It's a very intense atmosphere, you know anything goes wrong, you know a suit.

You're wrong at the right at a particular time when you're trying to sew something up, there's a tremendous pressure, and in between these pressures, you have to relax you.

You can't be keyed up and tight all the time.

And generally the tighter the situation, the harder things more You have to sort of fool around in between.

The more you have to look on the light side because otherwise you'd crank wait way big things that suddenly put him over the edge.

What's interesting is it often a tiny little straw?

Some offhand little comment are just getting the wrong result of just being given the wrong extra.

You're just picking up the wrong a piece of paper.

Once a guy loses his sense of humor.

What's A guy can't smile once a guy can't say good morning.

Once a guy can't kid with somebody else, you gotta work.

A sense of humor probably is our best defense being able to smile or a joke.

It can relieve the tension even if it might not always seem appropriate to an outsider.

After all, we deal with so much pain and suffering that often the only way we can talk about the things that touch us that upset us is by finding the humor in them.

I love working here.

There's a certain rhythm to our work, especially here in the emergency department way overwhelmed at times, often for hours.

It's quiet way.

Now is the time to take a break.

Swap a story, tell a joke.

Thank any pent up frustration.

Gotta wanted to get out, goes to pull it.

We No, no, no.

But the's hold important moments never seem to last long enough.

30.

Just when we're starting to relax, something always happens by clear.

I think it was a car versus truck leader.

She's a night.

It was I was gonna get a lining.

He's downstairs.

Change and you'll be on the dock.

Did you count down to a code like this?

One can be pretty nerve wrecking.

Even we we've been through it 100 times anticipation, preparation, checking and double checking.

No matter how well we briefed, you, learned to expect the unexpected way.

Yeah, probably way, way problems now.

Okay, Thank you.

Multiple codes.

Complicated ones like these.

This is recess at its best.

To an outsider, it could look like it's getting out of control.

But it is it This'd what we've been trained for.

A lot of us are prioritizing, making decisions, thinking fast, What's going on around us.

Our patients, each other away, part of a team were in it together.

We're also pushing ourselves to have minutes right out there on the edge.

It's exciting.

It's what draws a lot of us to this work.

And yet it's exhausting, too.

It's a routine that can eventually get to be too much, and it can wear us down, and it can burn us out.

This kind of an environment for some of us and at some stages of our life is a tunnel.

It gives us purpose.

It gives us a sense of doing something that is, uh, one of the most remarkable human endeavors you could do.

Oh, you're you're healing the wounded.

You're there where the action is.

You're part of something that is, it has a lure, and there's nothing wrong with a drama of coming to work and the urban mash unit of the trick.

On the other hand, after a while, that aspect of working in a place no longer has its special flavor.

It may not bring out of you rejuvenation, creativity, the good kind of arousal and instead because of many factors, often things going on in the rest of our lives.

Not what's going on here.

We lose that elasticity way, get more emotionally fragile on really we get hard.

Housekeeping.

Recess, please.

Housekeeping Reason.

This is aftermath of a code in which we have to have it.

I'm responsible for sending back up 10 minutes.

Ready.

Like many more guys, watch yourself hard, shoot out.

One of the things that can bring you down off that high in a hurry is the risk of infectious disease.

A lot of patients admitted to hospitals like ours are HIV positive or have AIDS.

Having to deal with that uncertainty is yet another stress.

Now you know to me, is like, yeah, with three colds back to about big ones.

I mean, I haven't been out of this room 34 hours, so it's kind of tough, and we got some new docks, and that makes it a little carrier than usual because they tend to be a little sloppy.

And then, if you don't get it, put back up and you're not ready for the next one.

So far, it's been another busy shift for Carol Taylor.

I'm on a lot of gas.

I'm due for a break.

She's getting tired, maybe even a little irritable.

That's when we need to find ways to ease off.

We all have our ways of relaxing a cup of coffee, something to eat a few minutes off in the lounge that can help this bed for sometimes you put your head down for a while.

I close your eyes for 15 20 minutes at house tonight.

There's always been something getting in the way.

You know, the second time in Europe, the second night woman sleep.

So you, you sort of start to adjust your clock a little bit.

1st 1 is kind of so these these people live in night.

I don't know how they it's bizarre.

Getting enough sleep is often easier said than done.

Too little for too long can really grind us down, so we have to be careful way have to take care of ourselves It's important to keep to the right things.

Get a little sleep whenever we can.

I've woken up in the middle of the night and bolted out of bed looking for a patient.

Started my room.

Uh, seriously.

I mean, I've scoured the room looking for I've called into the hospital.

I want to call the hospital for the person was on call here asking if I put in a central line.

It's a patient.

If I started a capital underneath, this patient's a serious procedure.

So you wake up with these delusions.

We've all had the occasional delusion when tired, have gotten angry at a patient bitter at the senselessness of what we sometimes see way Don't have any money.

That's human, Dr Davis, But we can't let it interfere with our work to things we had in a department.

She was the only one there.

Okay, just put that one resuscitation is running on because this here in here, you know, I forgot.

I didn't know this is in here.

All we have for you know what I know.

So you guys want to take this Take 10 to 109.

Can I finish?

You know what he's taking his many nights, the angle and menace of the city streets and sweep into way know that it's an emotionally charged environment way know that people don't want to be here.

They're not coming in for a well baby check.

They're coming in because they're injured or their hurts.

Or they are.

They're sick and and oftentimes they're angry.

And you see people that are very emotionally charged, and it brings out emotions in the health care giver that probably they would wish that they didn't.

They didn't have to bring out way, patched him up.

Shipped amount.

We deal with him for months that saying the intensive care unit go out.

You don't just come back next week, come back drunk and shot are you know, whatever it was they brought a main just brings him right back, so that part makes it better.

It's easy to get cynical and angry.

It's a natural reaction, but one which can diminish us as people and professionals, sometimes with patients.

It's not easy to have empathy for their problem, and I think that when you lose that empathy, uh, that you don't give us good care patients, and I get emotional, has patients, do care about themselves and do care about their recovery.

Have a family support system and you say your family family wanted somebody that identifies with somebody who you care about.

You want to do well for them because they really want to get that.

We all know how good we feel when we see how we've been able to help.

It's easy to connect with the patients and families we can relate to, but there's a downside when things don't work out.

We end up sharing the group in the pain.

And it was a C six quiet and really just a nervous wreck and he couldn't breathe on his own, was diaphragm didn't work and he had a wonderful family.

But he himself was just so anxious and he tried everybody's patience.

He was very demanding.

He didn't cooperate with the care, and I hear on days that I wasn't here.

He was really just awful because he and I ended up having a really good report, and it be days when I yell at him and then you know.

Then he said, I'm sorry we worked together, but then when I wasn't there everybody.

I'm so glad you're back.

You can have your primary bag.

So I guess the hardest thing for me.

One such called Sitting died.

Probably maybe a few days after you.

Like here.

You know, after all that work me up, put into it and everything, and I don't know, something happened.

And it's like he said before he left is gonna die.

D'oh!

When we've gotten this close to a patient, invested this much of ourselves in their recovery, their death can be very upsetting.

Most of us will try to leave these emotions here at the hospital.