You’re A Bad Ass

America loves its heroes. Firefighters battling blazes get respect. Coast Guard rescue workers pulling people from rough seas earn admiration. But physicians? We only get recognition when we’re dramatically saving someone who’s obviously dying.

Fifteen years as a hospitalist. Nobody has ever called me a bad ass. Not once. We deserve that recognition too.

America craves instant drama. Visible danger. Our work doesn’t look dangerous. We wear scrubs, not protective gear. We carry stethoscopes, not axes. We make decisions at computer terminals, not on burning rooftops.

So we don’t count.

But making decisions where being wrong kills people? That’s risky. Managing medications that could stop someone’s heart? That’s dangerous. Walking into work knowing you might tell someone their child is dying? That takes guts.

We do this quietly. No sirens. No cameras. All with constant pressure to document properly, discharge quickly, knowing all liability falls on us.

The Anesthesiologist: You put people to sleep knowing they might never wake up. Every intubation could end in aspiration and death. Every dose of propofol could drop blood pressure to nothing.

I watched an anesthesiologist manage a difficult airway during emergency surgery. Three attempts at intubation. Oxygen saturation dropping. The patient’s life hanging on whether she could get that tube placed.

She got it. Third attempt. Patient lived.

Nobody called her a bad ass. They just moved on to the next case.

The Intensivist: Every drug choice matters. Too much fluid causes pulmonary edema. Too little shuts down kidneys. Wrong antibiotic and sepsis wins. You make forty decisions that could kill someone before lunch.

The Hospitalist: You admit chest pain that could be heartburn or massive MI. Shortness of breath that could be asthma or pulmonary embolism. Abdominal pain that could be gas or ruptured appendix. Twenty patients daily. Each could deteriorate rapidly. The diabetic could go into DKA. The pneumonia patient could develop sepsis. The heart failure patient could have a massive MI overnight.

Firefighters face danger for hours. We face it for decades. Every patient could have a bad outcome. Every medication could cause harm.
Our mistakes don’t make evening news. They happen quietly in hospital rooms and clinic offices. But they’re just as real. Just as devastating. Just as permanent.
We make split-second decisions with incomplete information under enormous pressure. We carry responsibility for human lives knowing every choice could be wrong.

That’s being a bad ass. Your badge is waiting.

Jorge Sanchez, MD

Cali, Colombia

The Sunday Best 06/22/2025

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