In the emergency room I become a different person

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Dr Anda Cismas is a seemingly fragile woman at 168 cm. But only seemingly, because she can stand on her own two feet, both literally and figuratively. Classical ballet, jogging and aerobic were the sports she practiced in the past, and probably contributed to strengthening her discipline and willpower, so necessary to make it through the last wear of the Emergency and Catastrophe Residency Program.

Seven years ago, Dr Cismas was one among the hundreds of students who had graduated from medical school in Romania. Failed attempts in pursuing a specialization in paediatrics or psychiatry had only increased her confusion and indecisiveness regarding her professional future. Thanks to a good friend who asked her to be on duty with her in the emergency department, she became convinced of her next professional steps. Unfortunately, the healthcare system in her country did not suit her own expectations, so she decided to pursue a career in emergency medicine in another country.

A friend of hers, who was specializing in paediatrics and living in Belgium, advised her to try her luck in Belgium because the healthcare system is one of the best in Europe and offers adequate professional opportunities. A night spent sending her CV and cover letters to almost all francophone clinics in Belgium was not without results. Dr Cismas received lots of replies, but the most interesting offer came from a university hospital in Brussels which presented her with three possibilities: to pursue a competence in acute medicine for three years, to enter a residency program in Romania and afterwards spend two years in Belgium, or to pursue a specialization in Emergency Medicine and Catastrophe in Belgium for six years. Although it was the most difficult option, she chose the latter.

Dr Cismas did not have much knowledge about Brussels or Belgium; she only had that friend who encouraged her to come to this country. She started with an unpaid internship for several months, which was considered a ‘low skill job’ with not too many responsibilities, but very useful at that moment to familiarize herself with the healthcare system in Belgium. She supported herself financially, spending her day in the emergency room and when she had a bit of free time attending the courses with her Belgian colleagues, while also improving her French. Her Belgian colleagues were very kind, supporting her professionally – correcting her medical histories and helping her with diagnoses and the French language. It was only after two months that I conquered my fear and was able to answer the emergency calls, says Dr Cismas laughing. I wanted to give up so often in those two months. I did not understand much of what I was being asked to do because everybody spoke so rapidly and they had high expectations of me. It was as if I was paralyzed by fear. My colleagues have been supporting me a lot through all these years and they were all amazingly patient with me. “ Dissatisfactions were nevertheless present, coming especially from the paramedical personnel who had preconceived ideas about those from Eastern Europe. It took them years to change their opinion.

How did you know you chose the right specialization? “I was in the first year of residency in a hospital in a periphery when I diagnosed a hypovolemic shock in a patient.  She later came to me with a symbolic gift and thanked me for saving her life. I was impressed by the gesture. In addition, I like to feel the adrenaline during interventions in emergency situations. I change into a completely different person when I enter the emergency room; I am not the daily Anda anymore.”

I am curious to find out whether working in the emergency room is the same as in American TV Series such as ER or Grey’s Anatomy. “It depends on the days: I recently had a young patient, 34 years old, with myocardial infarction and then another one, 19 years old, who had attempted suicide, with multiple fractures … but there are also days when things are calm, with patients who come with chronic diseases.”

The hardest thing for Dr Cismas is to get over those moments when her patients die, despite every effort to save them. “Maybe it sounds strange, but I remember every patient of mine who died.  At the beginning it was very hard. I arrived home and was checking each protocol to see if I had followed every step, I was asking myself about all available treatments. Until one day when my supervisor invited me for a talk, helping me to see the situation from a different perspective. I have realized I cannot save everyone, no matter how well I do my job; a certain part is not under my control, it depends on God. Call it destiny if you like. The hardest is to stop when you have a child in your arms, or a person your age or of your parents’ age.”

When she arrives home, Dr Cismas becomes Anda Cismas, the person who likes to read, go to the theatre or simply to listen to music. She is lucky she is an optimistic and straightforward person, qualities that enormously help her to alleviate job stress.  The involuntary humour that comes with certain situations is also helpful: when she enters a patient’s house, she often is mistaken for the nurse or a student because she is a woman and only accompanied by tall men between 180 and 190 cm, the male nurses or the paramedical.

Three years ago, when she was going through a difficult period in her life, Dr Cismas felt the need to get her life in order and asked to be transferred to France to pursue an internship for several months.  It was the start of her career towards being a supervisor. However, she could not adjust to the French system that is different from the Belgian one in the sense that the emergency physicians have fewer responsibilities. So she returned to Belgium.

Her work, expertise, the ability to stay calm under pressure and her leadership skills have contributed to her being chosen as a supervisor, responsible for supervising the students and young residents in the university hospital where she is working. “Some students challenge me to read more but there are others who clearly do not find their place in the emergency medicine program. I also try to teach the basics to the latter because at one point everyone will be on duty independently of which speciality they choose. I hope they will find their passion one day as well.”

Although working in a university hospital is less appealing financially, Dr Cismas chose to stay because the academic environment offers her multiple opportunities for growth, access to a varied pathology and to advanced technology.

She stayed in Brussels because “my friends are here, those who have shaped me are here; I have always enjoyed working with them. This emotional part plays an important role in my work and maybe from a certain age you have to put down roots, and not only spread your wings and fly.”