Recently, I was back in the emergency department (ED). Not as an EMT this time but as a doctor. It’s different as a doctor. In the years leading up to medical school, I worked as an EMT in the ED and volunteered on an ambulance. Being an EMT was my first patient care experience. It was eye-opening in many ways. Among the things I learned as an EMT is that I did not wish to become an emergency medicine doctor. My residency program (internal medicine) has us do a month in the ED as part of our first year of training to get a different experience and a different perspective.

The ED is like no other place in healthcare or in the world. There are few places where the staff have as much camaraderie. There are few places in the hospital where the staff laugh so much and the adrenaline runs so high. The ED also, perhaps, provides as many reasons to cry as to laugh – which is why those who work in the ED find ways to pick laughter over sorrow.

The ED is the sorting hat of medicine. My rotation as a doctor in the ED showed me that ED doctors are the gatekeeps to the hospital and the safety net for everyone who can’t access healthcare anywhere else. The doctor’s role in the ED is different than that of the EMT. As an EMT my day was filled with tasks – placing IVs, performing EKGs, getting snacks for patients, and so on. As an ED doctor there are fewer tasks than as an EMT but the tasks that remain are heavy. ED doctors make big decisions about which tests a patient needs and where they should go next – home, surgery, a regular medical floor, or an intensive care unit. ED doctors stabilize patients before they are shuttled off to other parts of the hospital. ED doctors reassure patients that they are okay before sending them home. ED doctors are the last contact for many people as they leave this world for what comes after death.

Some days in the ED are hectic and some are slow. ED doctors connect with every other specialty in the hospital. They consult specialists and convince other doctors to accept ED patients so that the patients can be admitted into the hospital. As much as ED doctors are the gatekeepers, they are also the connectors.

The ED runs at a blistering pace but when things are running well no patient stays there for long. Hours, yes, but not for days. Yet, some patients become known to the ED. They’re called “frequent fliers.” Frequent fliers are known by their ED doctors much like primary care doctors know their patients. Often frequent fliers don’t have a primary care doctor. And, so, when ED doctors take care of a frequent flier they may be the only doctor that patient has. The only doctor standing between that patient and no medical care at all.

The ED is the sorting hat of the hospital. As the leaders of the sorting hat, ED doctors have many roles. They are gatekeepers. They are also connectors and, for some, the only option. The ED is the bridge between the outside world and the hospital. I’m grateful for the folks (doctors and all the others) who choose to work in the ED because being the sorting hat is no small feat.