The most interesting, thing, though, is the lavender survived the winter, and is regrowing right now!
One of the most magical things is when the sedum is in bloom, and there is the low hum of a bunch of bees at once pollinating. It's reminiscent of "Atmospheres", by György Ligeti.
Jeez I go away for a few years and I come back and Apollyon's turned into a poet, GeneralVeers has been banned, and almost everyone else seems like they are unhappy in their work.
I would say my life is pretty rich. Maybe not the richest possible life, somewhere out there in the "Everything Everywhere" multiverse I have a life where I own Tesla(the company not the car), CMG's are banned, and I'm married to Michelle Yeoh, but other than that my life is pretty rich. My family is healthy(now), my kids are pretty cool, and I'm still getting out of bed every day. Actually my wife is better than Michelle Yeoh but it fit with the "Everything Everywhere" reference.
Last 5 years I probably averaged 120+ hours per month seeing patients and preferred the busiest places. Now I work 4 days per month at a small critical access ED in a place where people from all over the world go to vacation. I get to do everything there. I work another 4 days a month in an academic inner city level 1. I never get to actually do anything there but I see cool pathology and learn from really smart residents, smarter than me. The rest of the month I can pick up extra shifts at either of the two part-time gigs, do locums if the price is right, travel, or just play in paradise.
I still think EM is fun. There is nowhere else in medicine where you get to see a completely undifferentiated patient, figure out what is wrong with them, and then do something about it. It's what we all probably thought all doctors did when we were kids. Every single patient is a black box, a mystery, a puzzle to be solved. Sure, often the solution to the mystery is "You are doing too much meth" Frequently the answer to the puzzle is "I'm sorry, there is nothing wrong with you I can fix" But sometimes you open the black box and find Churg-Strauss, methemoglobinemia, post-partum eclampsia with PRES, deep water oxygen toxicity or ehrlichiosis.
Sure there are entitled crazy patients and annoying families but every room you enter is a chance to meet someone new and interesting. I've met a guy with a Stanley Cup ring that looks like it hasn't left his finger once in the 50+ years since he won it. I've met actors, politicians, CEO's, diplomats, and rocket scientists. I've also met plumbers, electricians, commercial divers 1000's of miles from the ocean, and grateful refugees just starting a new life in America. I learned from all of them. I can put up with the annoying and entitled to meet the rest of them. Plus its easier to forgive the annoying and entitled when you realize that's just their response to fear.
I've worked a lot of nights, weekends, and holidays over the years. More than I would have in a 9-5 clinic or surgical subspecialty. My kids were sometimes pissed about that but I gained a lot too. I remember a lot of weekday mornings with the kids at a nearly empty zoo or aquarium when they were little. Everyone else's parents were working. Same with afternoons at the park or ice cream parlor. I remember pulling the kids from school for ski days or backcountry hut trips before we got more uptight about not missing school as they got older. I once worked 17 straight shifts at the beginning of June and 14 straight at the end of July. Took the 4 weeks off in the middle and the whole family went to Borneo and saw pygmy elephants and orangutangs in the wild and climbed Kinabalu. Didn't miss any work. I remember week long float trips and multiple weeks of vacation every year. More weeks a year than 9-5 America offers. Couldn't do that easily and keep an outpatient clinic running. Later we took an 8 month sabbatical from work and travelled all over Asia and the south Pacific. Still had a job when I got back. Couldn't have done that with a 9-5. So everything in life has trade offs but I like the ones I made in EM. You can still make those trade offs today if you want.
I tried some other things over the years. At one point or another I was a biochemist(maybe more fun than EM), Chief of staff(not fun), interim CMO(hated that one), director of informatics(interesting), COO of an SDG(engaging), C something or another of a start up(not the right person for that job), and even briefly a USACS regional VP(really hated that one). I realized that if I woke up in the morning and had a day full of meetings I just wanted to go back to sleep. If I had a day full of zoom meetings I wished I had died in my sleep. If I had a day, evening or night shift coming up I generally had a good feeling about the day. So, I quit all that other **** and I've just been seeing patients full time for the last 5 years and I'm happy. Hopefully I have another 5-10 years left. Staves off the dementia.
When I got out of residency the old guys all told me, "Its too bad you really missed the gravy years by a few years" Even though that was 20+ years ago it seems like we just keep telling the new grads the same thing and to an extent its true. But, I am incomparably more fortunate than my grandparents or parents. I'm not wealthy enough to fly first class on those trips I mentioned but my life is financially fine. Helps that we are still in the same house we bought when I was in residency and the average age of the cars in the garage is over 15 years.
Medicine is cyclic. I remember when people thought radiology was saturated but then imaging boomed and we needed way more radiologists. Maybe AI swings it back the other way, maybe not. I remember when Psych was the lowest paid specialty and almost no one, except for the people you knew were born to be psychiatrists, wanted to do it. Not any more. Anesthesia was so moribund that a friend got an interview and then a position outside the match at Harvard just for sending a postcard asking for an application. Then with pain and the increase in all sorts of interventions Anesthesia boomed. It will change again. I can't say it will necessarily change for the better for EM but it wouldn't surprise me. For now a lot of those residency spots created by private equity or HCA are going to go unfilled and there are tons of EM jobs out there. I'm getting emails every day with openings. I get texts about locums every week. If you graduated from an American medical school and went to one of the better EM residencies you will have dozens of places looking to hire you when you finish. The residents I've been working with all got to be pretty choosy about where they decided to work in the last few years. If they settled for less then their dream jobs it was often because other factors mattered more in their choice.
So here is the thing. If you like seeing patients and you like meeting new people you will always have a job in EM. The country isn't getting younger or healthier. You may not get paid as much as you would like or as much as you think you deserve but you will always have a job you like that allows you to live fairly well. If you hate EM, even if the pay doubles you will still hate it. If you enjoy the work you will be fine.
So, you can live a rich life in EM and I'm pretty sure that will continue to be true assuming you actually like what we do. If you don't like what we do you really should do something else. Less than a third of my residency class are still doing EM so you can do other things. As others have pointed out there are lots of other ways to make a living and you are only limited by your fear or your imagination or your work ethic.