Minimize Job Stress: Lessons From an ER Doctor

Emergency room doctor Gillian Schmitz shares her insights on balance, resilience and the village it takes to keep a family afloat.

By Meredith Heagney
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Dr. Gillian

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When you’re stressed about something at work, do you ever stop to remind yourself, “It’s not life or death”? That doesn’t work for Dr. Gillian Schmitz, an emergency department physician. 

For Schmitz, 42, work very often is life or death. She’s the person you go to when you’re bleeding profusely, when your heart stops pumping, when you’re doubled over from stabbing pains in your gut. Schmitz literally helps people survive life’s most stressful moments. 

That’s not to say she doesn’t have plenty of her own stress. She works about 60 hours a week, mostly at Brooke Army Medical Center in San Antonio, where she sees military service members and civilians. She’s also on the board of the American College of Emergency Physicians and an associate professor in the military and emergency medicine department at the Uniformed Services University in Bethesda, Maryland. This wide-ranging career means Schmitz travels about 130 days of the year. 

Like so many working moms, Schmitz juggles her professional and personal lives. She’s married to Matthew, an orthopedic surgeon, and they’re raising two girls, Kaylie, 9 and Austyn Grace, 7. 

We spoke with Schmitz to talk about living a high-paced and high-rewarding life. And stocked up on her tips for staying cool as a cucumber when work-place stress heats up.

The Plum: You knew going into emergency care that you’d have to manage anxiety. How do you deal with it?

SCHMITZ: The part about people dying, you have to separate it, or else you would never sleep at night. 

I would be lying if I told you I didn’t have to go outside sometimes and have a moment to calm myself down. I can distinctly remember, when I was in training, the screams of a mother when she lost her 6-year-old with asthma. The doctors did everything they could do, but the child just couldn’t get enough oxygen and died. 

Hearing those screams from a mother — and especially now, being a mother — you think of that a lot: What could we have done differently? Is there anything that would’ve changed the outcome? 

You just have to trust your training and make the best decision you can with the limited information you have at that time.

The Plum: Tell us about a recent time you saved someone’s life.

SCHMITZ: We had a patient who came in with a heart rate in the 20s. Normally, a heart rate is between 60 and 80, and when it starts going slower, you can get very weak. You can pass out. 

I had to insert what’s called a transvenous pacer to keep him alive. Essentially, I put a needle in his neck and threaded a wire down into his heart and then floated an electrode to stimulate the heart muscle to contract, to maintain his circulation and his blood pressure. 

We don’t do that very often, so that was exciting and scary at the same time.

The Plum: That sounds like a nerve-wracking procedure.

SCHMITZ: Yes, and you’re making these very important decisions with limited information. 

Many times, the patients we take care of are unconscious, and they can’t tell us their medical history. Or they just don’t know their medical history. Sometimes there’s a language barrier, or you have families argue over what they want.

You’re trying to be a marriage counselor and a doctor at the same time. 

Only 25% of emergency room doctors are women.

Association of American Medical Colleges
 

The Plum: Other than the life-or-death stuff, what do you find most stressful about your job?

SCHMITZ: I work some days, some nights, some weekends, some holidays; I don’t have a set 9-to-5 schedule. 

As I get older, that fluctuation in my sleep cycle is really tough. It takes me two or three days to bounce back from a night shift, whereas in my 20s I could do that no problem. 

And as health care changes, there’s more and more pressure put on us by hospital administration as far as how many patients you need to see per hour. 

There are many days I never get to eat during my eight- to 10-hour shift. I’m lucky if I have time to go to the bathroom.

The Plum: What’s the biggest stress in your personal life?

SCHMITZ: Managing my work life with my personal life. 

My husband is amazing and definitely helps, but because his hours are pretty rigid and he leaves at like 5 in the morning and often isn’t home until 7 p.m., the bulk of the home stuff still falls on me. 

We’ve had multiple nannies; some lived with us, and some didn’t. Now we’re down to 20 to 25 hours a week with a nanny. She helps with meal preparation and the kids’ laundry so I can maximize my time with my kids doing the fun stuff. 

The Plum: Do you deal with mom guilt?

SCHMITZ: All the time. 

The kids have a list of how many of their activities I’ve missed, so they keep me in line. It came from a family discussion about balance, and we promised them we would be there more than we are not. 

My oldest made a list to hold us accountable for her basketball season, to make sure we were at more games than we missed. 

I think about it a lot, and I lose sleep at night worrying that I’m not being the best mom. But I also think it’s good for them to have a female role model — seeing someone who does work and be a mom.

The Plum: You talked about work and family. What about time for yourself?

SCHMITZ: The mistake I see a number of women make is we put ourselves last, routinely. 

There’s your career, your spouse, your kids, your parents, whoever you’re caring for, and many of us don’t put enough time on just us. 

As your career starts to take off, that hamster wheel starts to turn faster and faster, and at some point you realize, “God, I don’t know how to get off.”

I’m trying to recognize when I’m not doing OK, when I’m feeling kind of snappy, or I’m not sleeping well enough and it’s time for me to step back. Even if it’s just a couple of hours of just getting my nails done or playing in a tennis league with my friends. 

I’ve learned that at some point in your career, it’s not always about the title. Earlier in my career, I wanted to climb that ladder and advance, and I’ve done that, and I’ve reached a lot of the goals that I had set for myself. 

That doesn’t mean I’m not still trying, but the additional cost of climbing one more rung in that ladder isn’t always worth it.

As your career starts to take off, that hamster wheel starts to turn faster and faster, and at some point you realize, 'God, I don’t know how to get off.'

Dr. Gillian Schmitz, Emergency Care Specialist

The Plum: What have you learned about stress from being an ER doctor?

SCHMITZ: A lot of the patients I’ve taken care of, you can tell their whole lives were working really hard, and the premise is, “If I work really hard now, I’m going to have this great life at some point.” 

But I think you realize that “some point” may never come and that there are always more things you’re going to put on your to-do list and more career aspirations. When you see someone in the ER die tragically after a car accident, you realize that tomorrow is not promised to anyone.

The Plum: What’s it like having to tell people their loved ones have died?

SCHMITZ: I usually try to get on their level, so I’m holding their hand or in some way touching them, if they’re comfortable with that. And you have to use the word “died,” you can’t say “passed away.” 

Some families, there’s a lot of screaming; some people get angry and try to hit you or punch the wall or get violent. 

If possible, I always hug families. That’s just who I am. Other doctors are not comfortable with that.

The Plum: What have you learned about the human condition from seeing people in these most stressed moments?

SCHMITZ: We’re incredibly resilient. Despite the sadness and the tragedies we see, people move on. We have to. 

You realize the strength that people have to get them through these horrific moments. 

As often as I come home sad or upset or crying over something devastating that I saw, an equal amount of time I come home laughing or joyous because of a funny story a patient told me or a connection with a World War II vet or doing an ultrasound on a pregnant woman, showing her the baby’s heartbeat.

The Plum: That’s surprising — you don’t think of an ER as a place where good things happen.

SCHMITZ: There are so many joyous moments in what I do. And I think I’ve realized how strong we are as individuals, that even in these really sad and horrible moments, that people come together. 

I’ve learned that we’re very resilient: You keep going. You bounce back. You get better.

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