Melanie Cole, MS (Host): You've seen the TV shows, but what is it really like to be an emergency room physician? Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and today we're going to explore a day in the life of a Henry Mayo Newhall Hospital Emergency Medicine Physician. Joining me is Dr. Oliver Sahagun. He's an Emergency Medicine Physician at Henry Mayo Newhall Hospital, and he's here to tell us all about this. Dr. Sahagun, always a pleasure to have you join us today. I'd like you to start by telling us a little bit about yourself, and when and why did you decide to become an Emergency Medicine Physician?

Oliver Sahagun, MD: Hi, you guys. Glad to be here. I've done this show before. And truly enjoy it. So yeah, my name is Oliver Sahagun. I grew up in San Fernando Valley. I live now here in the Santa Clarita area, which is where Henry Mayo is. I think that growing up I always wanted to be in medicine. I thought that I wanted to be a doctor. I knew that it was tough to become a doctor, but I knew that I would dedicate myself to fulfilling that goal. What specialty I was going to choose, really, I wasn't quite clear, but I think I came to that decision, later in my high school years when I joined the military and joined as an enlisted soldier, but my specialty in the military was an emergency medical technician, essentially the equivalent of a paramedic there. I knew that I wanted to do acute care medicine, and I, I thoroughly enjoyed that. Went on through college, continued to do monthly drills in the military, as a paramedic and knew I absolutely loved that. And so when I got into medical school, I knew I had all the options that every other medical student had to choose my specialty, but I was sort of at that point already laser focused that I wanted to be an emergency room doctor. Shortly after medical school, I was doing my training as an emergency room doctor.

 I continued my career in the military, but this time I was commissioned. So, I was actually a physician in the military as a reservist. I got activated, to go to a variety of conflicts, including the Balkan War in Bosnia, and two times to Iraq, both times to Baghdad. And seeing emergency medicine for what it is in that type of setting, not only in the civilian world, but also in conflict, really solidified my decision with emergency medicine.

And I'm happy I was able make that choice.

Host: Wow. Dr. Sahagun, what a story. Thank you so much for sharing that with us. It's very unique and also admirable because your field of medicine is high stress and fast paced, but also shift work, right? So you're not on all the time or on call, do I have that right?

Oliver Sahagun, MD: That's correct. I chose emergency medicine for a lot of reasons. Most medical students will choose the specialty that best fits their personality. And really I love acute care medicine. I like that fast-paced medicine and that really truly fit my personality.

But one of the things that medical students would choose a specialty for is lifestyle and I truly, truly enjoy shift work. I enjoy going to work, doing my job, but when I'm done, I'm done. I get to unplug. I don't have anybody calling me at home, managing care of patients on the inpatient side or asking questions about patients that I'm no longer caring for.

Emergency medicine is shift work. You go in, you do your shift, you come home and you could be the other person, the, the family person, which I, I am because I truly enjoy my family, my wife and my kids and my social life with friends and so one of the things that really appealed to me in emergency medicine is being able to do strictly shift work and not be on a call afterwards.

Host: Yeah, I find that very interesting. And aside from the hours which are long, what do you like most about your job?

Oliver Sahagun, MD: There's a lot of things that I like about my job. But one of the primary things that I truly enjoy is just the breadth and scope of medicine that I see in my patients. There are so many specialties in medicine. Some specialties are very laser focused and deal with just one thing.

 In emergency medicine, you deal with the whole gamut of medicine and I truly enjoy that. I enjoy the medical side, which is a lot of thinking and cognition. I enjoy the practical side, which is a lot of procedures. I enjoy dealing with adults. I enjoy dealing with children. I, enjoy dealing with behavioral issues.

I enjoy dealing with obstetrical issues and gynecologic issues. I, see the whole breadth of medicine from traumas to heart attacks to strokes to something as trivial as a common cold and ear pain. So in summary, one of the things I truly enjoy about emergency medicine is that no matter what walks in through the door, I'm capable and able to see it.

Host: Dr. Sahagun, what don't you like a little bit about your job. I mean, it's obvious we can hear in your voice the passion for what you do. Are there any aspects of it that don't make you as happy to do what you do?

Oliver Sahagun, MD: Every job for every single person has its likes and dislikes. I have way more likes than dislikes, but one of the hardest parts of our jobs is the emotional weight we carry. We're often the first to deliver devastating news. We're often the first to manage truly traumatic events, both in its physical and emotional nature.

Those moments don't always leave us, especially when it involves children or unexpected loss. Before I was married and had children, it was easier to deal with. But now when you see children in physical anguish, mental anguish or children that are truly sick, children that come in with horrible accidents or in drownings, that's just extremely, extremely hard to to deal with.It takes a mental toll that people outside of medicine just don't always see.

Host: How do you deal with that?

Oliver Sahagun, MD: It's hard, but you learn to deal with it. I think it takes a special personality from the very beginning, but then you learn to deal with it as you go along. But, when you're at work, you just learn to unplug because if you have an emotional attachment, there's no way you're going to be able to do your job.

One moment, you're taking care of the sick child or elderly man, and the next moment you just have to unplug because a cardiac arrest comes in or horrible trauma comes in or a stroke comes in. And so, you just have to learn how to emotionally just disattach yourself from the moment.

Most people can't do that, but most ER doctors are, are very capable in, in that regard.

Host: It is certainly a rare ability that you ER docs have to anticipate that kind of stress and then deal with it and as you say, compartmentalize what is going on. I don't know that I could handle the waiting, knowing that something tragic is going to happen, knowing that even if it's a quiet day, you just never know.

So tell us, what are those days like in the ER? Even if it's a quiet day, are you always all on prickly edge waiting for the next thing to happen? Or what is a day like for you?

Oliver Sahagun, MD: Every single day what that I walk into that emergency room, I already know the part in the hallway where I always ask myself, what am I going to see today that I haven't seen before? I've been doing emergency medicine for 20 years and I've seen a lot, but probably at least once a week I will see something that I haven't experienced before and I am always expecting the unexpected. I think I'm at a point in my career where I'm not on edge anymore. Maybe in your first or second year out of residency, you might be on edge, but that doesn't work well for you, because you always have to expect the unexpected, to provide the absolute best care at a moment's notice for anything that walks through the door.

But every day that I walk into that emergency room, I'm always expecting the unexpected, but hoping that I have the wisdom and wherewithal to make sure that all my patients, come out of the emergency room safe and satisfied.

Host: I'd like you to tell us about your team because certainly there are so many people. An emergency room is a very busy place and there are intake managers, there are nurses, there are other doctors, and then there's the techs for all the scans and things that have to be done. Tell us what that's like and how do you all work around each other and work with each other without bumping into each other?

Oliver Sahagun, MD: Yeah, so I mean, that's one of the things that I truly enjoy about the emergency room and the emergency room is a very well-oiled machine. People don't understand that if you were civilian or you're coming into the emergency room to take care of yourself or a family, it seems like chaos, but to us it's organized chaos.

It's entropy at its finest. Everybody knows their job. Everybody knows their responsibility. There are so many facets to the emergency room and providing care for patients in a very proficient, efficient, and compassionate manner. There's a whole team of, providers and nurses and therapists and other ancillary staff, case managers, technicians that work hand in hand with each other to make sure that the job gets done.

And I truly, truly enjoy that. You know, I consider myself to be a fairly social person and, I truly enjoy the teamwork that goes into taking care of every single patient that walks into that door.

Host: Dr. Sahagun, if there was one thing you wish people knew about hospital emergency departments, what would you like that to be?

Oliver Sahagun, MD: Well, I mean, just going back to what we talked about, I wish people understood how much coordination and thought goes into every decision we make for every single patient. We're not just reacting, but we're prioritizing our patients based on severity, coordinating care with specialists and navigating limited resources while trying to treat everyone with the attention they deserve.

It's also very important to know that emergency departments are often the safety net of the healthcare system. We care for everyone regardless of whether they have insurance, a primary care doctor, or even a place to sleep. We're trained to do this, but it means we also take on a lot of societal issues in addition to the medical ones.

Host: Have you ever come across a situation where you didn't know? Where you felt like, I don't know what's wrong with this person, and you brought in the specialists and you learned something really amazing?

Oliver Sahagun, MD: What happens a lot. I mean, I, consider myself to have a very wide sort of scope and breadth of medical knowledge, but not everything in medicine is textbook. Not everything presents the way you expect it to present, and every once in a while you're going to have an enigma. But the most important thing that you can do as a physician, especially an emergency room physician, is recognize an emergency.

You may not know what's causing the emergency, but you have to be able to recognize it and stabilize the patient and try to save the patient until a diagnosis is made. Sometimes you could see a patient who comes in, in respiratory distress and quickly decompensates to respiratory failure. And you're wondering what happened?

Was it an asthma attack? Did they choke, did they aspirate? Do they have a collapsed lung? Do they have a penetrating injury you're unaware of? Do they have a horrible pneumonia? Is there fluid in their lungs? But once you can recognize the emergency, you, you can provide treatment. And sometimes that might be as drastic as sedating him, intubating them, and put them on a breathing machine until you can order the appropriate diagnostic tests to try to figure out what it was that put that patient into respiratory failure or, anything else.

Host: Dr. Sahagun, as we get ready to wrap up, I have sort of a two part question here. I'd like you to speak to the community about Henry Mayo Newhall Hospital's emergency department in particular, but before you do that, what would you like all of us listening to know about what we see on TV? What pisses you off when you see shows like ER and Grey's Anatomy and all these different shows now there's that show The Pit. And when you look at these shows, do you get pissed off? What would you like us to know about what we're seeing versus the reality?

Oliver Sahagun, MD: When I was in medical school, I used to truly enjoy those shows, and so I could see the value in it. I think that when the lay person watches those shows, it glamorizes the emergency room and that sort of brings a smile to my face. But the reality is, is that being an emergency room doctor is not all glamor and glitz and it's very emotionally trying.

Now I watch those shows and I see the doc on the show making 18 extremely difficult diagnoses in a day's work. And we know that doesn't happen. You know, emergency room medicine is a collaborative effort with nurses and technicians and therapists and ancillary staff and paramedics and other physician

 specialties and it's just not the ER doctors. It's a group effort and people need to understand that sometimes coming in with a specific ailment may be something as easy as you have ear pain, but it could be something horrible, like a brain tumor.

And sometimes a lot of diagnostic tests need to be done in order to make that specific diagnosis so that we can provide appropriate care.

Host: Now speak to the Henry Mayo community and what you would like them to know about your emergency department, the people that you work with, your team, and your approach to whole body wellness, to caring for this person and their families who are beside themselves when they come into the ER.

Oliver Sahagun, MD: Henry Mayo is a very special place. I live in Santa Clarita. This is my hospital. We're not an academic center, but sometimes we function like one. Henry Mayo has a lot of specialty designations, many of which are very pertinent to the emergency room, we're a trauma center. So if you're involved in any sort of trauma, we got the capabilities of seeing you. Some traumas are very bad. And, we work closely with LA County Emergency Medical Services Agency to come up with criteria to determine what truly is a trauma. So if you meet those criteria in the field, that information is relayed to our bay station, by our paramedics so that when you come in, we are absolutely ready to take care of you with a whole team of individuals that are going to take very good care of you, from nurses, to doctors, to surgeons, to anesthesiologists, to blood bank.

We're also a primary stroke center, so if you have symptoms that are consistent with a stroke, that information is also relayed to our paramedic bay station, and we're waiting for you when you get here to provide excellent care, very thorough, and efficient diagnostic workups so that if you're having a stroke, we're going to be able to take care of you.

 We're also a STEMI receiving center. Which means that if you're having chest pain that turns out to be a heart attack, we have very capable providers in the emergency room, and especially cardiologists that are going to be able to take care of your heart attack. We also have a behavioral health unit attached to our hospital. So if you come in with a, an emotional or psychiatric crisis, we have very capable people including psychiatrists and psychiatric nurse specialists that are going to be able to take care of you and hospitalize you if needed.

We have an excellent OBGYN department. We deliver hundreds of babies every year, which sometimes starts in the emergency room or we provide follow-up care for these folks in the emergency room to make sure that the pregnancies are progressing as needed. And if need be, we have people that's going to help take care of you. So, anything that comes in through that front door we're going to be able to take care of you.

Host: The best care, collaborative, comprehensive, and compassionate. Thank you so much Dr. Sahagun, for joining us today and really telling us the realities of what it's like to be an emergency medicine room physician. Henry Mayo Newhall Hospital and its emergency department are open 24/7 and it's located at 23845 McBean Parkway in Valencia, California.

You can learn more@henrymayo.com. You can also always visit the free health information library@library.henrymayo.com. There's so much great information there and it's quality information that you know you can trust. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital.

Please also remember to subscribe, rate, and review It's Your Health Radio on Apple Podcast, Spotify, iHeart and Pandora. I'm Melanie Cole. Thanks so much for joining us today.