After we met in a hospital in Cape Town and he laudably showed me both how to start IV lines (something nurses do in the States, so much appreciated) and how not to contract TB (also appreciated), Robbie asked me to write an entry for Pondering EM on the topic of why a comedy writer would choose emergency medicine as a specialty.

Briefly, before I went to medical school I wrote for Jimmy Kimmel Live for eight and a half years. Having been involved in well over a thousand episodes of television and with a quite comfortable professional life where I worked with hilarious, interesting people while getting eight weeks of paid vacation a year, I then had a brief psychotic episode in which I applied to medical school. Having gone through many residency interviews and thankfully matched, I still don’t have an utterly simple reason for the switch. (NB: in the US we start residency training in a specialty after medical school, and only after residency are we fully-fledged attending physicians; I know the rest of the world has similar training patterns, just with more incorrect terminology). Jimmy was and still is an amazing boss and human being. My coworkers were some of the most wonderfully interesting people I have ever met. Whatever complaints I managed to drum up about being a highly-paid late night writer, I was always deeply aware that they were incredibly dumb in the scheme of things. Medicine just seemed really, really interesting to me. So I dropped out of the television business as well as most of my life, and four years of medical school at UCLA in Los Angeles later, I have a month before I graduate and begin insisting that everyone call me doctor.

Having given an array of unsatisfying answers to the question “Why medicine?” in my residency interviews, I may as well move on to the next question – “Why emergency medicine?”

There are, of course, the obvious reasons a comedy writer would find the emergency department appealing: the nocturnal existence, the precarious zoo atmosphere, lots of thinking on your feet, the need to make decisions that are at least partially instinct and impulse – not to mention the inherent inability to form lasting human connections and an abundance of shameful food items that everyone somehow convinces themselves will help them do their work but just end up making them feel sad inside.

Most comedy writers and comedians would include the above items on a list entitled “Things That I’d Like To Have Be Part Of All Work Environments Forever.”

There are differences, of course. The cult of outdoors activities that has sadly gripped the emergency medicine community worldwide has thankfully yet to invade most of the comedy world, which is protected by both a moat of crippling self-awareness and a kindly indulgence for an absence of physical fitness.  When I began interviewing at residency programs, I decided to be radically honest (versus the incredible mendacity of my day-to-day) and so found myself saying things like, “I don’t want to be somewhere where people play beer pong after mountain biking after beach volleyball after ziplining.” This had less to do with my being too good for those things than knowing that I’m terrible at all of them. Describing how much I would hate to go on what I presumed to be their annual resident rafting trip (which it turned out the program did indeed have), I said, “If everyone wants to go rafting, I’ll go along once just to fit in, and after that I’ll fake all manner of illness to avoid ever doing it again.”

Which I never thought was a selling point to programs at all – I know I sound like a misanthrope! Who hates social gatherings! Which is only partially the case!

Anyway, may as well be upfront. And for the record, I walked off a mountain in Cape Town, parachuted to the ground, and landed without vomiting and/or crying. But given my druthers, I’d just stay inside and return phone calls while eating a tin of muffins.

Comedy culture has its own negative aspects, too. Emergency physicians, by dint of being doctors, are incapable of the sort of casual emotional brutality that serves as a tent pole of the world of comedy. The things that come out of the mouths of people who are professionally funny are often disturbing, usually terrible, and frequently true. Needless to say the moment I began medical school I decided to lock that part of my brain in a vault forever. It is a profession where being mean to your colleagues is a good thing – and the more creative the cruelty the better. Everything is said without hesitation as a matter of course. That sort of wanton rancor would be a terrible addition to medical training, and it is best confined to emotional pachyderms.

But my oh my, it does keep you on your toes.

It was always amusing to me when, during my clerkships, some resident or attending would begin giving me their opinion about my work, usually trying to be “constructive” rather than purely critical. All I could think was, “I’ve been called fat on national television! More than once! So let me have it already!”

But that wouldn’t be right, in part because the hierarchy of medicine includes the unspoken caveat that you cannot fight back. In comedy you can hit back as much you want and more. It’s an egalitarian lunacy.

Which is something else that appealed to me about emergency medicine. Perhaps because of its relative youth, and perhaps also because of the stakes involved, there is less of the hierarchy in the field than I see in other specialties. I appreciate order and structure (honest), but the relative equality of emergency medicine resonated with the comedy writer in me.

It has been said that comedy is as close to true justice as exists in real life – if you are funny, you are funny, and if you aren’t, then there is nothing that can hide it. Emergency medicine often treats very frightening, fast-moving pathology, and being good – not your dress, not your pushiness – is what matters. It seems to my pretty untrained eye that the short windows between presentation and decision allow that sorting to become clear faster.

Perhaps also because of its youth, it has a remarkably collaborative spirit, much as a good writers’ room has when the comedy engine is oiled well and firing on all cylinders. People in emergency
medicine seem to enjoy seeing each other succeed, and they seem to like helping one another. Both of which were pleasant findings for me.

In comedy there is often little time to meditate on that day’s shortcoming and failings. You digest them, learn what you can, and move on – there’s another show that needs to me made tomorrow. Emergency medicine, too, has the tomorrow-try-again ethic, if only because today’s successes and failures are now done, and tomorrow is going to bring a whole new set of patients and problems.

And, as in comedy, the only thing you can do is learn something and improve. And then maybe over time, suddenly it’s workable as a job and the weird world you’ve joined feels familiar and maybe not so insane after all.

Of course, I could be wrong about all of this – I’m still a medical student, after all. So there’s always business school.

Jacob Lentz is a medical student at the David Geffen School of Medicine at UCLA. In June 2015 he will join the UCLA Emergency Medicine Residency Class of 2019.