Dr Louis M. Profeta is an emergency room physician in the United States. He's been specialised for over three decades of ER training, and is the author of the 2010 best-selling novel ‘The Patient in Room Nine Says He's God’. He received residency and specialist training in Pittsburgh and has been working in his home state Indiana since then, providing him with expertise in the American healthcare system. As a continuation of his novel, Dr Profeta has been up to date in writing ongoing articles surrounding general medicine, emergency medicine and much more. This was following the major audience he gained from his novel. His appearance on TEDx for Wabash College received over 200,000 views on YouTube, in which he highlights the eye-opening journey of practising in the emergency department. The resilience underlying his emergency physician career, seen through the several pandemics where his profession was in need, has shaped him to be a passionate, resilient and noble doctor in the healthcare system.
Could I potentially get a back story on your career, how long you spent in medical school, training and so on to become an emergency physician?
'Well, in the United States, I completed four years of college after high school, followed by four years of medical school. I then went on to complete three more years of residency at the University of Pittsburgh in emergency and trauma care. Since 1993, I've been a full-time practising physician at a level one trauma centre, so essentially 31 years. I'm presently the oldest practising ER doctor in our trauma system.
During my residency, I was a doctor on a medevac helicopter. I had a pre-hospital care license, called an EMT license. I’ve also worked in biomedical engineering for a biopharmaceutical company - which was during college. I then became a bestselling author; I speak all over the United States at college and university campuses about drug and alcohol abuse issues on campus. Through all of this work, I've managed to achieve a reputable social media audience.'
What was a changing point in your life that encouraged you to choose this specific pathway of being a physician in the ER?
'I was an accomplished gymnast during high school, believe it or not. I had aspirations to go to the Olympics; following this, I had an accident and broke my neck. At the time, it undermined my future of being an athlete. It was during this period of being an inpatient that I fell in love with medicine, the whole idea of it. The thing is, I wasn't a good student at all. If I'm being honest, I barely got into college; but when I did I locked myself in the libraries for your years and pretty much pushed through with all straight A's to get into medical school. So synthesise, my passion for medicine came about from my injury. Initially, I thought I wanted to explore hand surgery as a specialist but soon realised that I was struggling with neck pain attempting to lean over the operating tables. My surgeon informed me of this issue, leading me to realise the short duration of my career if I did pick this speciality. Simultaneously, I was working in the emergency department and ended up falling in love with it. It was a new field in the United States; I've been in it for over thirty years, and 160,000 patients I think I've encountered over this course.'
Did you ever find the process of medical school and residency difficult?
'The hard part in the US is getting into medical school. The biggest struggle would be to achieve the grades, the profile and the curriculum vitae for medical school entrance. Surprisingly, I found the medical school process easier than the undergraduate degrees in molecular biology. I mean, I found my passion through it and would always engage in reading. I had an incredible hunger for everything medical-related, so I took every single opportunity I got to read and learn. In other words, I found medical school to be relatively easy, and I enjoyed the clinical rotations. Residency, however, is significantly difficult, especially in terms of working hours. Currently, a resident can't work over 80 hours per week, a work-hour restriction that didn't exist during my practising time. 80 hours a week is still considered a significant amount, but when I was practicing it often escalated to 110 to 120 hours a week. This remained consistent for three years. In all honesty, it was exhausting being a resident, especially in the 90's. I practice medicine through HIV, the AIDS epidemic, the H1N1 pandemic, COVID-19; and more volunteer work in military zones. I've seen a lot.'
From my general knowledge of the ER, I assume that working in the ER demands a substantial skillset, especially where the ER's nature is unpredictable given all circumstances. Have you ever found it difficult working so broadly where you're expected to be so versatile and solve whatever comes your way?
'Yes, but that's the joy and beauty of emergency medicine, honestly. It's being able to deliver a baby one minute and treat a gunshot wound the next, then a child with meningitis, or even an overdosed patient. It's quite literally what makes this job so exciting; you won't know what happens. It could go from calm to raging in a matter of seconds. The adrenaline rush that I get on this job is knowing that anything possible could come in but not knowing what it is up until the very minute. I used to lay in bed at night during residency playing the worst possible scenarios in my brain over and over then asking myself ‘What would I do for example, if a haemophilia A patient who was pregnant came following a car accident with the following blood pressure etc…’. I’d simply lay there and go over extremely complicated emergency scenarios, and I found it rewarding. The difficult aspect of emergency medicine is being able to truly compartmentalise the horrible situations you see when you get home, but not mentally take them with you.'
Is there a specific way you deal with the emotional aspect of the career?
'I’ve written an article titled ‘These Four Words That May Offend You May Also Just Save You’, those four words are ‘it's just a job.’ You do have to realise that at the end of the day, being any kind of healthcare provider is a wonderful rewarding career, to take care of yourself and those around you. Ultimately though, it is just a job. I said a while ago mentally that I'd do everything I could, but I can't always win. On top of that, I'd be lying if I didn't mention my incredible support system at home, an incredible partner - I wouldn't have been able to do this job for 31 years if it hadn't been for her. Achieving this level of career stability encourages you to have a partner or a support system of some sort who will move through life with you. To be quite frank, I believe that's a highly under-appreciated aspect of a medical career.
I'll go even further and say that the primary idea of ‘work-life balance’; is a bit of a facade. The most important thing in your life is yourself and those around you. In general society, doctors and nurses can be replaced day after day if they encounter death. To your family, however, you're irreplaceable. Ideally, you want to be in a stable and good position mentally. So no, it's not a balance; you and your family always come first, then your career. I think those who tend to become burnt out approach their career being a higher priority than being a husband, a wife and so on.'
Is there a specific experience you’ve encountered that has your mentality so firm on the idea of ‘family over career’?
'I've told this story before around a decade ago; my oldest son fell ill in New York City and was then diagnosed with leukaemia. In the moment I dropped everything and ran to New York and slept in a chair next to his bedside for seven months. I cut all my work off and did not think about losing my career, I'm a dad first. I'd give up my career in a heartbeat for my son. Hence, when we discuss balance, think about it from that standpoint. Don't sacrifice your life for this job.'
You've written a book titled ‘The Patient in Room Nine Says He's God’. Could you tell me what it's generally about and the inspiration behind crafting it?
'It's about spirituality through the emergency department and more general aspects through medicine. There are lessons I've learnt about life, myself, and so much more. It discusses aspects of forgiveness, salvation and understanding the routes we travel in life, like the importance of family for example. It takes important life lessons from the emergency department and how it's shaped me as a person and my understanding of having a higher purpose. In honesty, I wrote it for my children in an attempt to explain why I sometimes may be in a bad mood, or why I remain unattended to their school events. I had no intention of doing much about it until some attraction was gained. It was after I wrote a few more articles, it blew up and became a best-selling book.'
Would you say that the articles are somewhat of a continuation of your novel?
'In a lot of ways, they are. After finding a larger audience, I've shifted to writing articles, for example, one that dealt with youth sports in America. We're quite fond of kid sports here, but it does have negative impacts on parents, marriage and finances. The article blew up and became one of the most-read articles on social media and won an award from The Society of Professional Journalists as one of the best sport-based articles. My book then followed with the audience, LinkedIn then reached out to me requesting to have an article on ebola written. Because of the large audience I've acquired now, it's not fitting to publish another book; every article I write usually reaches between 25,000 to 2 million reads and I mostly use LinkedIn as my primary writing base. I've been quite careful with my role and voice in the world; I didn't want to just write to be controversial, I wanted to make a genuine difference.'
During COVID-19, the majority were alarmed with the death rates that were essentially proliferating. Was there ever a moment during this time when you and your colleagues were fearful for our future?
'Absolutely. In the beginning, we were terrified. I was one of the older doctors, so when COVID appeared I was already 57 years old. We were mostly monitoring the early virus in Italy and kept hearing news about healthcare workers passing. My wife encouraged me to retire although I insisted on working; my kids also had to leave New York. It was horrifying, the changes I had to make to my daily routines were profound. Everything here was shut down; I'd go to work every day wondering if today was the last day I'd be alive. We did, however, manage to observe early on that most patients who were dying were old people with previous health issues or morbidly obese people. This information reassured me when we also observed that none of the nurses or doctors on the team were dying. I felt more calm going into work, and when the vaccines finally came along; it felt like going out of the woods. Despite this, it was still horrendous at the start. We were practically holding up phones as patients were dying, visitors weren't allowed; and people were essentially watching their loved ones die over the phone saying their last goodbyes as we held the phones for them.'
You're quite adapted and used to the idea of ‘dying patients’. Starting your residency and being a junior doctor, did you ever find the first of these experiences emotionally weighing?
'Yes of course. There is nothing that prepares you in the studies leading up to being a doctor; people usually say ‘I want to be a doctor', ‘I want to go to medical school', but you never really learn how to be a doctor until you've reached residency. Some of the things I've seen were just horrifying honestly. I remember a lot of the tragic events in which I'd have to announce many patient's passing with their specialist doctor. The thing is though, the death of a patient doesn't sway my mentality as much as the reaction of their loved ones finding out. The families' reactions are the moments that tend to keep me up and awake.
Being an ER physician in my hometown, I've run cardiac arrest on friends of mine and people I’ve known growing up. Not to mention having to diagnose people I've been surrounded with my whole life. In a way, there is a sense of burden in practising medicine in the same area you spent your childhood in. Essentially speaking, I do believe in the nobility of medical doctors and favour the idea that at any given moment I may be able to change the path of a person's life for longevity; even if it was one more patient. That's why I plan to continue showing up.'
Specifically going into medicine and being a physician, does that require or demand a particular personality or morality of some sort?
'I believe it does. If there's one thing; you have to be resilient. Not compassionate, empathetic, but resilient. The reason is that you can have all the compassion in the world, but if you’re finding yourself burnt out 5 years into your medical career, it’s so difficult to continue. When you get sent to medical school, the field is demanding that you work in that environment for 25 to 30 years. A lot of doctors cut off their practice after half a decade or so because it's not what they've envisioned or some other issue. You've got to be resilient; you have to love the science and be willing to put up with all the cons of being a doctor; likewise with other careers.'
Do you have any critical pieces of advice you'd like to share for undergrad, or high school students with a focus on the medical field and its rigorous careers?
'Find a mentor; so a physician of some sort. You want to approach the reality of medicine with curiosity, so sit with your mentor and enquire about the truth. When I was in college with my EMT license doing medical engineering, technically I wasn't in medicine early on. During medical school, I then took on jobs with a cardiologist, and a hand surgeon; so a lot of the mentorship came from when I was in medical school. The thing is though, I also had mentors in terms of growing as a person, which were my classmates. A Lot of them have become inspiring individuals who seek their research and are now extremely successful. These people were my roommates too, so I was constantly seeking advice from them when I left high school being quite clueless on how to study. You can find mentors in every single aspect, so pick up as many as you can move through your life; be open-minded essentially.
Think about what your life goals are, I'm speaking from a family and professional standpoint. Take your time and attempt to have an idea of where you see yourself two decades from now; try to understand whether it's fitting for you before you rush and head straight into it. As I mentioned earlier, you have to approach medicine with the mentality that it is a long-term career, so be sure that your mentality is up for it. Be curious too, there are hundreds of specialities; read about them first, then spend some time in each before finalising your choices. Your future is constructed through your own decisions, so take control of it. It might sound quite daunting, but move towards it with courage. Be passionate, seek out experience and help. It determines your success.'
Madelynne's comment
My interest to study medicine was triggered through the curiosity of biochemistry alongside healthcare systems. As my goals became transparent, I wanted to reach out to aspects of real life that I may encounter. This joint project with a good friend Loe, was established when we realised the similarities of our career pathways. The 'About us' page provides a purpose of our website and why it was created.
I'm profoundly grateful for being given this interview opportunity. As a younger student lacking real-life experience, I want to look at medicine from a standpoint of spirituality and character development rather than the job itself. The underlined parts throughout are details I've found touching and believe readers of this article would benefit from hearing.
Our instagram: https://www.instagram.com/lm.medicine/
Below are links to Dr Profeta's website, where you can find all educational written articles, an overview of his best-selling novel, and his TEDx talk:
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