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ER doctor: 'Stress? What stress?'

Song-Yih Tu, M.D.  


Dr. Song-Yih ("Sonny") Tu


I'm a junior assistant attending in emergency medicine at St. Luke's-Roosevelt Hospital Center (SLRHC) in New York City. I'm Emergency Medicine Board prepared, which means I've completed a four-year residency in emergency medicine and am undergoing my specialty licensing-board exams -- they'll take another year to complete.

The title "junior assistant attending" sounds strange because it's an academic title bestowed on me by the medical school we're affiliated with -- the Columbia University College of Physicians and Surgeons. If I worked in a regular old emergency room which had no medical school affiliation, I'd just be "an attending."

What do you think about working overnight -- what Dr. Tu calls his special "talent?"

Out of the question.
Maybe for more money and a shorter workweek.
Yeah, like Dr. Tu, ovenight work agrees with me.
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Time in position

I joined the emergency department staff in February 2000.


I'm 33, an Aquarian. I was born the year of the Monkey by the Chinese zodiac. But I hate bananas. I'll eat any other fruit.


I attended a 7-year "accelerated" medical degree program in NYC. This means I went straight from high school into medical school. Supposedly, this meant I was rather precocious. However, I've always known what I wanted to do with my life so an accelerated med program was what I really pursued. After medical school, I trained in a four-year emergency medicine residency program in the Bronx.

How did you get your current job?

I sent out my curriculum vitae and considered a number of different emergency departments in the Tri-State area. Some ER directors, having seen just my CV and my special "talent" (see next answer), offered me a position over the phone without even meeting me. But SLRHC really attracted me for a variety of reasons. I asked my then-chairman to make a phone call for me to SLRHC and set up an interview. The rest, as they say, is history.

How many hours do you work per week? And what are your hours -- as in, what time of day or night?

Ah, now to my special "talent." I work exclusively night shifts. An ER, like a 7-Eleven, is open 24 hours per day. Therefore, you need to have staffing around the clock. A person who works exclusively nights is highly valued by most ERs because this means the rest of the attending staff has to work fewer night shifts. I get to work at 10 p.m. and generally don't leave until after 8 a.m.

What's the first thing you do when you get to work in the morning?

I usually get to work about 10 minutes before my shift starts. The first thing I do when I get to work is scope out the waiting room on the way into the ER. Judging by how many people are out there, I usually can tell whether I'm in for just a regular bad night or horrendous night. Then I set up my music -- hours of MP3s on my laptop played through a boom box. (Soothing music is so key on overnights. It can bring a surreal quality to what happens sometimes but mostly it keeps people happy and calm.) Just before taking sign-out from the attending I'm relieving, I use the restroom -- depending on the night, it might be the last time I get to go.

What time do you have lunch? What do you usually eat?

Lunch? Who has time for lunch? I live on coffee, Coca-Cola and Doritos while at work.

What time do things get tense around the office? What makes it that way?

Song-Yih Tu tells us that St. Luke's-Roosevelt Hospital Center "is actually two different hospitals with the oldest having been around since 1846. St. Luke's Hospital is a Level 1 Trauma Center and serves most of West Harlem. Roosevelt Hospital serves the Upper West Side of Manhattan and was established in 1871. Between the two sites, we see around 110,000 patients annually in the emergency department." And we met Dr. Tu when he used our submission form here to tell us about his day on the job. Click here to do the same.

Things are generally the most tense when I first get to work. Sometimes, there can be a couple of hours' wait to be seen by a physician for non-urgent patients. I have to take "sign-out" from the attending I'm relieving. This involves walking around the entire ER, peeking into each room and going over each and every case there. In essence, I have to learn every single case in the emergency department at that time, commit them to memory and continue each person's care as if I've known them and taken care of them since they came to the ER. Often this means learning 15-25 cases in a short period of time during "sign-out" rounds.

As we walk by each patient's room, when asked I usually tell them we're taking "attendance". Things can get tense if the patient behind the curtain perceives there's been an excessive wait time. I usually tell them a doctor will be by soon to see them but that can be met with varying responses -- on occasion, I've been yelled at by some angry patients.

If you're having a good day at work, what is it that makes it good?

No one dies and I get to go to the bathroom more than once during the shift.

How much work, if any, do you take home?

I take a lot of work home with me. When I get home in the morning, I'm still very stressed out and generally don't go to sleep until a good three or four hours later. I guess this can be considered taking work home with me.

I'm also responsible for teaching the residents, so I'm constantly reading medical journals and going over interesting cases for presentations. Also, I have a responsibility to my patients to keep abreast of new medical developments and treatments. This involves constant recertifications and journal reading.

I find MD Consult on the Web an invaluable source for looking up journals and textbooks. I'm also involved with research projects with a few of the residents. We usually meet outside the hospital in a more casual setting to discuss what we're doing.

What does your work contribute to society?

I often wonder this myself, even though the answer seems obvious. In my more jaded moods, I think my work goes against what society wants and the greater good of mankind.

Darwin's theory of evolution holds that the strongest survive and the weakest die, thereby ensuring only the best genes will be propagated. One could construe what I do (and the entire medical field, for that matter) as being anti-evolution. But I truly believe every life is sacred, and therefore everything must be done to ensure the well-being of that life. Moreover, I'm not in the position to judge anyone's life -- to consider one's person life more or less important than someone else's, therefore more or less worth saving or continuing.

Do you expect to finish your working life in this career?

Absolutely -- unless I can feed myself, pay my rent and medical school loans off doing nothing.

If you could have two more careers, what would they be?

I've always wanted to be a race car driver. To that end, I Autocross my Mazda Miata on the weekends. The speeds in Autocross aren't that fast but there's nothing like the melding of man and machine with tires squealing in the heat of competition.

I'd also consider becoming a professional photographer specializing in landscapes and stills.

What are unforgivable traits in a colleague?

"I truly believe every life is sacred, and therefore everything must be done to ensure the well-being of that life. Moreover, I'm not in the position to judge anyone's life -- to consider one's person life more or less important than someone else's, therefore more or less worth saving or continuing. "

Laziness and hypocrisy.

What do you do to relieve stress?

Stress? What stress? Seriously, during the winter, I ski as often as I can. During the summer, I can most often be found in the Band Shell or on "the loop" in Central Park rollerblading. In general, I just stay active to blow off steam.

What have you been reading lately?

Annals of Emergency Medicine (February issue); "Harry Potter and The Sorcerer's Stone" by J.K. Rowling (Arthur A. Levine, 1998); Harry Potter and The Chamber of Secrets (1999); New England Journal of Medicine (this week's); Car and Driver Magazine; Medical Economics; "Goldfrank's Toxicologic Emergencies," 5th Edition, by Lewis R. Goldfrank (McGraw-Hill, 1996).

When you have one of those days on which you don't think you can face the job again, what is it that gets you out the door in the morning and off to work?

Honestly, I haven't had one of those days yet. I just really love my job. I guess I'm one of the lucky few who not only loves his job but also has been moderately successful at it as well. Hopefully, I'll never have a day like that. If I ever did, I know it'd be time for me to leave the field of emergency medicine.

When it comes to dealing with people's lives, if you don't love what you do, you'd better not be doing it.


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Columbia University College of Physicians and Surgeons
MD Consult

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4:30pm ET, 4/16

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