When I was growing up, there were two things that I wanted to be more than anything: a doctor and a writer. Before I pursued medical training, my very first dream was to be a novelist. My childhood journals and old home computer were always littered with story ideas and the beginnings of novels. Even as I prepared for a career in medicine, I also maintained my love of storytelling and writing. I majored in American History & Literature while doing my pre-med classes, I pursued a journalism degree prior to going on to medical school and I started working as a freelance writer. When I began residency in Emergency Medicine in 2015, I knew that writing would have to take a backseat as I completed my clinical training, but it's also something I've missed a great deal over these past few years.

That is why I’m so excited to share my new essay, "Exposed," which appears in the latest issue of Annals of Emergency Medicine. I’m grateful for the opportunity to join these two passions, to take an experience in medical training that was challenging and formative and share it with others in my specialty through creative writing.

In the emergency department, we deal with a large volume of sick patients. Not only are many acutely ill, but they are often undifferentiated. Our daily lives include encounters with sepsis, STEMI, and shock and no shortage of other surprises. As a result, we develop a certain level of comfort with these high-stress situations.

Yet there are some encounters that move beyond even the daily ebb and flow of high acuity. These are the scenarios that make us break out in a cold sweat as the CMED call comes in. The ones that can form a knot in our stomachs even days or years later. Every clinician has cases like these that are seared into their memory, cases that help us grow as doctors.

We sometimes refer to such patients as 'sick as stink' (SAS) - or even use a slightly more colorful version of the phrase. Though couched in the typical irreverence of the ED, this reference is not used in a derogatory manner. In fact, the expression is one of humility for the ways in which medicine can always continue to surprise and challenge us. It communicates a necessity for vigilance to our colleagues. It is an admission of how much a case affects us. These are the patients whose faces we can conjure effortlessly, who will become a symbol of what we learned, the unforgettable cases.

​SAS will be a recurring column on this site, a collection of my most memorable cases (de-identified as always). They will be mainly educational (rather than esoteric), meant to consolidate and share what I learned from these high stress encounters. I hope you enjoy the first installment!

SAS - Episode 1

​-J

As I near the halfway point of my third year as an emergency medicine resident, I've been inspired to shake the cobwebs and dust out of the right side of my brain and start writing again. In a previous life, I was a journalist and research writer, but after four long years of medical school and about two-thirds of my residency, that person started to feel a little foreign to me. After finally completing a long-term research project and experiencing the pride of seeing it in print,  I began to long for the different but just as powerful feeling of crafting writing born of creativity and imagination rather than spreadsheets and statistics. Starting with the clinical training of my third year of medical school, I've had less and less time for these activities. But I promised myself when I started out at medical school that this part of me would not disappear, that even if it went into a period of hibernation, I would bring it back to light. Now I finally feel that a cloud has started to lift. As the scaffolding of emergency medicine becomes sturdier (though certainly not yet complete), there seems to be space for this other, equally important side of myself.

The goals of this site will be severalfold and I'll attempt to outline them now to give myself a framework moving forward.
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• First, it will be a journal and witness to my experiences in the field of emergency medicine. For me, it will be a catharsis on the days that deplete me and a reckoning with the challenges of the practice of medicine. For anyone reading, I hope I can offer some small amount of inspiration or insight.
• ​Some pieces will explore a clinical vignette. Some will be educational in nature. Some will offer opinions on aspects of practice. Some will be weighty, while others may be humorous. All will deal with the practice of medicine, its blistering highs and searing lows, its strange intricacies and customs, its failings, and, most importantly, its rich stories.
• While I will always endeavor for accuracy, these pieces will not be exhaustive reviews of the medical literature and should not be taken as such. If specific clinical information or patient stories are presented, details may be omitted or changed in order to fully safeguard the privacy of my patients and my colleagues.
• Most often, I will speak to those in the field of emergency medicine, to my resident colleagues, attendings, other EM physicians, nurses, physicians assistants, EMS and all those who have chosen to inhibit this peculiar, strange, exhilarating and sometimes heart-breaking corner of clinical practice. But I will do my best to write in a manner accessible to other clinicians and to the general reader.
• And finally, a dry, but necessary disclaimer: All views and opinions expressed on this site are and will be solely my own and do not represent those of Brigham & Women's Hospital, Massachusetts General Hospital, the Harvard-Affiliated Emergency Medicine Residency (HAEMR) Program, ProEMS Center for Medics or any other institution with which I am affiliated. While I will discuss medical topics and the practice of emergency medicine, views expressed here do not constitute specific medical advice or clinical practice recommendations.

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And with that, I'd like to re-inaugerate joshuacolin.com. For all of us, clinical practice is just one facet of our lives. I hope that this site will serve as a new outlet for me, to inspire creativity, learning and excellence in clinical practice in both myself and others. Thanks for visiting and enjoy!

J