EM Collective Wisdom: Daniel Egan

Author: Daniel Egan, MD (@danjegan, EM Residency Program Director, Mount Sinai St. Luke’s Roosevelt; Associate Professor of Emergency Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

It is hard to believe that I graduated from medical school 16 years ago. Even after all that time, I still love clinical emergency medicine. I remember being in medical school and loving all of my rotations and wanting to still have exposure to everything. The excitement of cases and acute resuscitations still draw me in on shift, and admittedly I love the adrenaline rush. It is an incredible feeling to know that you have a home and family at work in the hospital made up of similarly minded people and personalities in the ED. Honestly, however, as the years have evolved, what really keeps me going in EM is the patient interactions. I work in NYC, and our patients are challenging. But the incredible part of this job is the exposure we have to be the doctor for patients and their families at their worst times. There are very few specialties where a physician gets to walk in a room, gain someone’s trust, and share in their experience. Even more than that, there are few specialties where on a daily basis you deliver good news and bad news and realize that the words you choose and the manner in which you deliver that news will impact people forever. I love this part of our job. For years I think I felt like it was necessary to maintain a wall or a barrier to the emotional part of our specialty. However, since going through family illness with my father years ago, I have embraced that emotional piece more and try to be the doctor for people that we didn’t really get during his illness. It has changed my outlook and has helped me to avoid the burnout that is so prevalent in our field by making sure that the human piece is present on my shifts.

2) Most impactful case. 

This is a really tricky question to answer as there have been so many cases which have impacted me. I have a memory from my first night on call as the intern in the PICU doing CPR on a two-year-old victim of child abuse and crying. I can recall the times when I got it wrong, especially during residency when I saw my name on the screen for M&M. I can think about the times when it has been all the glory associated with saving a life. My most impactful case though takes me back to the MICU of my intern year when I received a patient from the ED who was my age and dying from sepsis. As a novice doctor without a lot of knowledge yet, I watched this rapidly progressing disease refractory to all therapy. His nurse (now one of my best friends) and I had to take him to MRI, and on the way to the elevator he went into cardiac arrest. We went back to the MICU past his whole family doing CPR. I watched him go in and out of arrest while completely waking up in between and seeing the fear in his eyes. I saw brilliant nurses and doctors literally try everything they could to save a life. I watched the ICU attending conduct a family meeting talking about the time to let go in this young, vibrant guy. I watched a family grieve their loss when he ultimately died. I had so many emotions after the case and have often thought back to him as one of the first times I experienced such a traumatic loss for me emotionally. I learned so much that day, including how to let people say goodbye and to grieve with families about their loved ones. I have obviously seen tragedy innumerable times since then, but I think the early time of my training has kept that with me forever.

3) Most important career decision leading to satisfaction.

I think the most important career decision was deciding to get involved with resident education. As a program director, there are many parts of the job that are time sinks without a lot of gratification (filling in forms, attending a lot of meetings). But the most satisfying thing in the world is watching young novice residents turn into practicing physicians who we send out into the world to take care of others. There is literally nothing like getting a text message from a former graduate excited about something and wanting to share it with me, or to talk about how they felt prepared for whatever they encountered. There is a parental fulfillment in coming to a shift and getting or giving sign out to someone who previously was in your training program. These are the moments that motivate me to keep doing what I do in education, to strive to be a better teacher and mentor and make me have no regrets about my career decision.

4) What does future of EM look like?

EM is rapidly evolving. Our specialty is a leader in delivery of education, innovation and bringing change to the world of medicine. I believe the future is bright in terms of our expanded scope of practice, our place in the society of medicine, and the rising leaders in our field with brilliant scientific and educational agendas. I think more and more we will see members of our specialties as leaders both locally in medical schools and more broadly in the house of medicine and that excites me.

5) Greatest achievement / why giving back is important.

I think thus far in my career my greatest achievement has been becoming a program director. When I get past the day to day administrative duties of the job and think more broadly about what it means to be a PD, I realize that the opportunity to mentor and lead a group of residents through their training is an incredible honor. I was taught by some amazing people over the course of my career and so in some ways I hope that the feeling I get when I think about my own PD or faculty members happens to my residents as well. Creating a culture of resident-centered training where we challenge them to work hard and be prepared for real life while paying attention to wellness and balance is what I have strived for in this job.

6) Favorite failure.

It is tough to think about a failure in the context of being favorite. I recently shared a story at an All NYC EM conference when we did an M&M storytelling. While I will not go into the details in this post, I had a case about 8 years ago that has stuck with me because of a missed diagnosis. While ultimately I think I met the standard of care, I think often about subtle red flags or gut instinct and whether I fully listened. It was also the first time I met a family after a bad case and experienced their anger and obvious loss of faith in my abilities as a doctor. I think about that case often and how I try to channel that energy seeing patients now and in teaching residents about decision-making.

7) One thing you would change about our field.

I look forward to a day where it feels like the ED receives the same attentiveness as the rest of hospital institutions. It is challenging to have some portions of hospitals function on a Monday to Friday schedule while we continue to take care of patients off hours. I also struggle continuously with the ability of other units in the hospital to not take report, to close beds, and to maintain strict staffing ratios while our departments explode and hang on to people in order to maximize other units. I hope I will witness a time when better surge protocols and buy in from larger organizations to support the crowding, boarding, and strapped resources in the ED occurs.

8) Something that you love that has indirectly impacted your EM career.

People talk about the inability to take care of others if you aren’t taking care of yourself. Growing up, music (in particular singing) was a huge part of my life. I was actively involved in high school and college and then lost that during the early parts of my time in medicine. Since reclaiming that interest and being involved in a large chorus in NYC, I have been re-introduced to that passion and also now have regular interactions with people outside of medicine which I think helps to make me a better, more relatable doctor.

3 people you’d like to see fill this out

1) Tiffany Murano

2) Mike Gisondi

3) Linda Regan