It’s hard to believe I’ve been practicing emergency medicine for nearly 30 years. I’ve seen a lot over the years—some things I’ll never forget, some things I try to forget, and a whole lot in between. Through it all, one thing has stayed the same: the ER is unpredictable, fast-paced, and demanding. It requires your mind, your body, and your heart to be in the game every single day.

People often ask how I’ve stayed sharp all these years. The truth is, it hasn’t always been easy. But I’ve learned a few things along the way—lessons that have kept me grounded, focused, and, most importantly, effective.

Showing Up, Shift After Shift

One of the first lessons I learned early in my career was simple: show up, and give it your best. That might sound basic, but in emergency medicine, showing up means more than just being physically present. It means being mentally clear, emotionally steady, and ready to make decisions that could change or save someone’s life. No matter what’s going on in your personal world, the patient in front of you deserves 100% of your attention.

That’s easier said than done, especially on back-to-back shifts or when sleep is short. Over the years, I’ve had to figure out how to leave distractions at the door, how to stay focused even when the waiting room is overflowing, and how to take one patient at a time, no matter how chaotic it gets.

Experience is a Double-Edged Sword

The more years you spend in emergency medicine, the more you’ve seen. You recognize patterns faster. You learn to anticipate complications. You develop a kind of sixth sense—what I call “clinical intuition”—that helps you see through the noise and get to the heart of a problem. That kind of experience is a gift, and it saves lives.

But it also comes with a danger: complacency. After a while, it’s easy to think you’ve seen it all. That’s when mistakes happen. One of the ways I stay sharp is by reminding myself that every patient is new, every case is unique, and every day in the ER is a chance to learn something. Medicine evolves, people surprise you, and no two situations are ever exactly the same.

I’ve made a point to read, attend continuing education, and listen to younger colleagues. Sometimes they’ve got newer ways of looking at things that challenge my habits. Staying humble and curious has kept me from getting stale.

Taking Care of the Body and Mind

Emergency medicine is physically and mentally taxing. The shifts are long, the pace is intense, and the emotional weight of what we see can wear on you. If you’re not taking care of yourself, you’re going to burn out. I’ve seen it happen too many times.

For me, staying active is a big part of staying sharp. I make time for the gym. Not because I’m chasing fitness goals, but because it clears my head and gives me energy. I also play the guitar and try to make space for reading and quiet. These things may not sound like much, but they help me reset and recharge between shifts.

Faith has also played a major role in keeping me centered. In a job where you see both miracles and heartbreak, having something to lean on outside of yourself makes a difference. For me, that foundation has been a steady guide when the job gets heavy.

The People Around You Matter

One thing I’ve learned is that you’re only as sharp as your team. Emergency medicine is never a solo act. Nurses, techs, medics, fellow doctors—we all rely on each other. Over the years, I’ve come to deeply appreciate the value of working in sync with a solid team. When the ER is firing on all cylinders, it’s like a well-rehearsed orchestra. When it’s not, you feel it fast.

I try to lead with respect and gratitude. A calm voice, a listening ear, and a little humility go a long way. You don’t have to be the loudest or smartest person in the room to lead. You just have to care, stay steady, and be someone your team can count on when the pressure’s on.

Learning from the Tough Shifts

Not every shift ends with a high five or a good outcome. Some nights, you walk out feeling like you gave everything and still fell short. That’s part of the job. But those are also the moments that can teach you the most—if you’re willing to reflect and grow from them.

I try to ask myself after a hard case: Did I do my best? What could I have done differently? What did I learn? It’s not about beating yourself up. It’s about staying honest and committed to improving.

Still Grateful After All These Years

After nearly three decades, I still love what I do. It’s not always glamorous. It’s certainly not easy. But there’s something incredibly fulfilling about being there for people when they need help the most. It’s a privilege to be part of those moments.

Staying sharp in emergency medicine isn’t about being perfect. It’s about showing up, staying curious, taking care of yourself, trusting your team, and never losing sight of why you started in the first place. If you can hold on to that, you’ll stay sharp—no matter how many years go by.