Do you feel something is missing in your life? What do you wish you could do more of? It’s time to put it on the calendar. After today’s episode, you will understand why.
Dr. Tanya Dall is an emergency medicine, wife, and mom...but not necessarily in that order. This week, we discuss finding balance between work in the emergency department and at home. We will also hear about Dr. Dall's journey into medicine, how she chose emergency medicine, and how she has been able to accomplish all of that while also raising a family. This is an episode you don't want to miss!
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Finding Balance With Dr. Tanya Dall
We're talking to Dr. Tanya Dall. Dr. Dall is an Emergency Physician in Southern California who also works in rural medicine in Arizona. She's also a wife and a mom of two. Welcome, Dr. Dall.
Thanks for having me. I’m happy to be here.
We're going to talk a little bit about balance and finding balance, but first tell me a little bit about your background. Where did you grow up?
I grew up an Army brat. Where I grew up is hard to say because I grew up everywhere. I was born in North Carolina, Fort Bragg. We spent a couple of years in Germany, a few different places in Virginia, Panama, down in Central America, which was an experience I could talk for hours about. I ended up in middle school back in Arizona in my mom's hometown called Sierra Vista in Southern Arizona. When people ask me where I'm from, I normally say Sierra Vista, Arizona because that's where I feel like my family is and that's where my roots are. That's my early years.
I didn't know you lived in Panama.
We lived on a military base back when the Army had a base down there right next to the Canal. I lived in military housing and our backyard was the jungle. We had this big huge chain link fence that would separate our yard from the jungle and we would find holes underneath the fence, climb under, go escape and go do a bunch of adventure stuff out in the jungle. I was in my first grade. My mom called us free-range children, meaning she let us do our thing. I have a lot of stories of being in the jungle, getting into trouble, swimming with crocodiles and stuff like that.
When did you know you wanted to be a doctor?
In fifth grade after school, I would go home and we had one of those big TV that would sit on the ground with the dials and things like that. My favorite thing was to go home and turn on this show called Trauma: Life in the ER. I would not remember it except that it made such an impact on me, which is why I remember it. I would remember sitting there watching these real ER cases play out.
People would come in with gunshot wounds. It was a trauma center and they would show the resuscitations, thoracotomies or whatever on the screen. I remember being fascinated and blown away by that. That was my first look into the world of medicine in general. That's when I started thinking more about going into medicine and what that might look like.
I love that they showed the real resuscitation. One of my first memories of thinking about emergency medicine was the show ER. It's maybe not as realistic as what you described. I was still very impacted by that too. Is that what made you decide to go into emergency medicine? Did something else change later on?
That was when I started thinking about medicine. In terms of thinking about what I was going to do when I grew up back when I was little, my mom would always tell me, "You need to do something where you can support yourself and you're never going to need another person to rely on." It's always in the back of my head, I wanted to consider things that were higher-income professions because I wanted to be in a position where I wouldn't need anybody else for anything. I could provide for my family and give them anything that they would have ever wanted.
People think about being lawyers, doctors, sports and things like that. That was when I narrowed it down. Medicine interested me but also, I saw myself being able to establish that security and have that for myself and whatever family I might have one day. My first exposure to medicine was with trauma. That was where my interest always was. In college, as an undergrad, I volunteered in the emergency room. I remember seeing my first dead body.
How does that affect you? You said you were an undergrad.
I was a freshman and I was volunteering in an emergency room, which meant nobody talked to me. Nobody knew I was there. I would go around and bring people blankets and restock shelves.
It's funny how you can disappear in the ER. You're doing little tasks and observing in the background.
Literally, I would sneak into rooms and stand in the corner and no one would know I was there. I would watch all the resuscitations. I’m like a fly on the wall. I remember walking by this room one day, peeking in and noticing that the guy was very pale and wasn't moving. It had a blanket up over his face. I'm like, "What's going on in there?" Nobody was in there. I peeked and snuck in and saw him. He was dead. That was the first time I ever saw a dead body. It was shocking.
Now, we see dead bodies every day and were like desensitized to them. That was an experience for sure. I did emergency medicine, volunteering as an undergrad. Fast forward to medical school. It's the third year in medical school where you get to see the different specialties. You do your rotations. You rotate to internal medicine and surgery. I did an anesthesia rotation. You can pick different things. We did psychiatry. We did pediatrics. You go through all the different rotations.
I remember hating the OR because it's freezing cold. I'm normally a little chilly and if you put me in a room that's 60 degrees all day, I was miserable. The other thing that I love to do besides being warm is eat and drink all day. In the operating room, you can't eat and drink. Now, you sit at work with your coffee. It takes at least a couple of hours to get that cup of coffee down. In the OR, you can't do that. You have to stand on your feet in one stationary position for some of these cases are 6, 7, 8 hours, even 10, 12 hours and you're standing there.
I remember that as a medical student too, where you're standing and it's like all of your bones hurt because you've been standing there for long. I had an attending who told me that sitting is the new smoking. I was like, "If that's the case, I want a cigarette so bad because I want to sit." It can be exhausting. Those cases can last forever.
You have to go pee. You get hungry. You can't do any of those things. You stand there. The OR was not for me. The other thing that was not for me was a clinic. The clinic is way too repetitive, not exciting at all. I don't find joy in talking to 30 patients a day, each for 15 minutes about their blood pressure medication. I don't find joy in that. I knew the clinic was not for me. The other thing I knew that was not for me was rounding in the hospital.
Rounding for nonmedical people, you get to the hospital super early. You log into the computer. You check all your patient’s labs and imaging. You're doing what we call like a pre-round on these people to see how they're doing. Once you have the data that you've collected, you go room to room. You go see the patient, you examine the patient and this is still pre-rounding. This isn't even the rounding.
Around 6:00 AM, you've pre-rounded on all of your patients. You've come up with plans for the patients. You go back around with the whole group this time, including the attending, the pharmacy, everybody. You go in, you formally round on the patients, you have to present the patient and tell everybody about their labs and imaging for the day, what's going on with them and what the plan is. The thing about rounding that's terrible is you will round until probably 12:00 or 1:00.
You can't put your life on hold for your medical career. You have to keep continuing to live your life and do both in parallel.
By the time that you're hungry, you think you could die. I'm a snacker. I eat every hour. I have to be eating something. If I don't eat for a couple of hours, I get really hungry. I can't make it until 1:00 PM when I get to the hospital at 4:00 AM. You round and round, you feel like it's never going to end. Rounding an inpatient medicine was not for me. I always knew I loved emergency medicine. I was making sure that I didn't want to do any of those other things. I made sure that I did not want to do those other things and then fully committed to emergency medicine.
That's such a useful exercise for medical students to hear or to go through because you need to take advantage of year 3 and year 4 of medical school to figure out what are things that I like, what are things that I don't like.
Are you saying to yourself, "How do I feel on this rotation? Am I happy, stressed, bored? Could I see myself doing this every day for 40 years?" For all those things, my answer was, "I can't even do this for six weeks. No, thanks."
You fell in love with emergency medicine. What is your favorite thing about emergency medicine?
I love the entire field of emergency medicine. I could go on and on and list a hundred things that I love about it. One of the things that I love about it is, I feel like the doctor where if something happens and somebody says, "Is there a doctor?" You don't want a dermatologist to raise their hand. You don't want a radiologist to raise their hand. Those are doctors but not like super practical and helpful.
I feel like in emergency medicine, we are literally trained to be able to handle anything that comes in the door. It's 3:00 AM. You're the only one there. A lot of the specialists are not in the hospital overnight. When something comes in, you either know how to handle it or you have enough experience and knowledge to figure out a plan about how to handle it. That is probably one of the best parts of our field. I feel like I can help. I'm always there to help no matter what happens, people can put their trust in me.
Another thing that I thought was interesting, people will say in emergency medicine, you're like a Jack of all trades but a master of none. That's BS because we are masters of resuscitation. I had this the other night. I had a guy come in with chest pain at 3:00 in the morning. The tech brings me the EKG from the front lobby. I haven't even seen this guy. He checked in, they bring me the EKG and it looks like a STEMI.
A STEMI means heart attack.
A bad news heart attack. I told the tech, "Get this guy back here right away." They bring him back to the room. I meet him in the room. I immediately start asking him, "What are you feeling? Are you having chest pain? When did this start?" All the questions to figure out to confirm that this is a STEMI. I talked to him. I decided it's a real deal. I walk out of the room and I get on the phone with the cardiologist.
I'm literally dialing the phone when he codes. He goes into V-fib, which is a cardiac arrhythmia that is not consistent with life. You cannot live with V-fib. I dropped the phone, run in there and had him back within 30 seconds to a minute. I defibrillated him and ran the code. We are masters. That's what we do. If you get a urologist and that guy codes, what do you think the urologist is going to do? I'm saying we can do resuscitation unlike anybody else. When people say masters of none, I laugh internally because I know that's not true because we can do things that probably 95% of other doctors could not do.
Having a broad perspective on medicine, we see everything every day from somebody who needs their toenails trimmed to running a code. There's a lot that we see that you may not see in other specialties. That gives us a little bit of a broader perspective to think about different diagnoses. We do tend to think the worst first. That is our job.
We have to. People will come and they'll apologize and say, "I'm so sorry. I'm wasting a bed. I shouldn't be here." I tell them, "You were worried enough to come in to be evaluated. It's my job to figure out if you have an emergency. It's not your job. It's your job to get here when you think something's wrong. It's my job to figure out what's going on." We think of the worst always.
What is your least favorite thing about emergency medicine?
The thing that disheartens me maybe the most is dealing with the other specialists. In the emergency room, we'll see the patient and then we'll come back to our desk. We spend half our time on the phone calling consultants, admitting patients, telling people what's going on, calling family. Sometimes when you call consultants and they are the specialist in that specific field. When you have a question and you want to call them or you need them to help you with something or you want them to see the patient and you call them. Sometimes they can be less than humble.
We're always trying to advocate for our patients and trying to do what we think is best for them. If I think the patient needs a cardiologist, I call a cardiologist. I don't need the cardiologist to be condescending and disrespectful towards me or talk down to me. Especially, I feel this as a younger female too. We don't get the inherent respect that a lot of other people would get, especially over the phone.
They're like, "Are you the doctor? Are you the PA? Are you the nurse?" They assume they're talking to a PA or a nurse. Even if you introduced yourself sometimes it can be rough on us. That can be disheartening sometimes. Your job is to be on call. You're getting paid to do that. The bare minimum is to answer the call and be on call. Don't yell at me, berate me, talk down to me or disrespect me. It happens. It's probably one of the worst parts of our job, I'd say.
That's a good point that you bring up too about how much time we spend on the phone. Especially in the emergency department, we'll see a patient and spend maybe ten minutes if we're lucky with that patient. Patient thinks that we're not doing anything for them but in reality, we're spending much time calling different consultants. We're checking labs ordering labs, trying to figure out why the patient hasn't been taken to the CT scanner or why this particular lab hasn't resulted yet. That time adds up to 30 minutes or 1 hour sometimes per patient. There goes your entire shift on the phone.
We get surveys from patients that tell us about their experience and how it was. A lot of times, I'll read those patients will say, "The doctor was in and out. They were only in the room for five minutes." People just don't understand. They don't know what goes on behind the scenes. I'll even tell people when I step out, "I'm going to step out. I'm going to review your labs. I'm going to call the hospitalists to tell them about what's going on with you. I'll be back in a while to see how you're doing." You’ve got to update. I tell people what's going on. I don't know, they'll never understand.
They might if they read this, they'll understand. You're a supermom. You had a baby during medical school and another baby shortly after the residency ended. I personally barely survived medical school without worrying about pregnancy and preparing to be a mom. Tell us a little bit about what it was like going through pregnancy during medical school because I can't imagine.
It was not easy, to say the least. My husband and I met freshman year of college so I was 18 when I met him. We got married when I was 24. We moved across the country and he stayed with me for medical school. As soon as we had moved into DC, he proposed to me. It's almost like we were together for long and there was a script of how you're supposed to go on.
"We've been together five years. What's the next step?" We go and get married. We're back and we're like, "Now, we're married. Aren'