Emergency medicine is not for the faint of heart. It demands quick decisions, long hours, and the ability to move on from hard moments with little time to process them. Over the years, I’ve had people ask me, “How do you do it? How do you keep going without becoming numb?” The truth is, there’s no perfect formula. But I’ve learned that balancing grit and grace is not only possible—it’s necessary if you want to survive this line of work and still love it.

I’ve worked in ERs across Alabama for nearly three decades. I’ve seen everything from car accidents to cardiac arrests, drug overdoses to childbirth. Some days, I walk out of the hospital with a sense of deep satisfaction. Other days, I carry the weight of loss, mistakes, or just plain exhaustion. It’s easy to grow hard, to build emotional walls as a kind of defense. But the best medicine—both for the patient and the physician—still comes from a place of compassion.

Grit Comes First, But It Isn’t Everything

Let’s start with grit. In emergency medicine, grit is your foundation. It’s your ability to stay focused during chaos, to keep your head when others are losing theirs. Grit gets you through the night shift when you haven’t slept. It’s what helps you stay sharp during back-to-back traumas. It’s your shield when a patient yells or a family’s grief overwhelms the room.

There are moments when you simply have to push through, even when you don’t feel like you have anything left to give. I’ve worked 24-hour shifts, handled multiple codes in a row, and walked into rooms knowing the patient’s odds weren’t good—but showing up anyway. That takes a certain toughness. And yes, there are times you have to compartmentalize to get through it. But grit alone isn’t sustainable. If you rely only on grit, you’ll burn out. You’ll stop feeling. And that’s when the real danger sets in—not just for your patients, but for your own spirit.

Grace Is What Keeps You Human

Grace is the part of this job that doesn’t get talked about enough. It’s quieter than grit, but just as powerful. Grace is what allows you to pause for a moment after delivering bad news and put a hand on a grieving family member’s shoulder. It’s what reminds you to treat every patient—no matter how difficult—with respect. It’s the voice in your head that says, “This person matters,” even when you’re overwhelmed or frustrated.

I’ve seen how easy it is to slip into cynicism. When you’ve treated the same overdose for the fourth time in a month or seen someone use the ER for issues that aren’t urgent, it’s tempting to grow jaded. But then you remember: everyone has a story. Everyone is carrying something. Grace lets you hold onto empathy, even when it would be easier to turn it off.

There’s one night I remember vividly. A young man came in, unconscious from a heroin overdose. We worked on him for what felt like an eternity. He survived, barely. Later that night, I saw his mother in the waiting room, crumpled in a chair, clutching a picture of him as a boy. That image stopped me in my tracks. He wasn’t just another drug user. He was somebody’s son. And grace reminded me to treat him that way.

Finding the Balance

The real challenge—and the real art—is finding the balance between grit and grace. You have to be strong enough to endure what the job throws at you, but soft enough to stay connected to the people you’re helping. Too much grit, and you become mechanical. Too much grace, and you may find yourself overwhelmed by the emotional toll.

I’ve had to learn this balance the hard way. Early in my career, I let the job consume me. I thought being tough meant never showing weakness, never letting a patient’s story affect me. But over time, I saw how unsustainable that was. I started leaning into the moments of grace—saying a quiet prayer in the trauma bay, taking an extra minute to explain something to a scared patient, asking a nurse how they were holding up after a rough case. Those little acts of humanity matter more than we sometimes realize.

Staying Grounded

What’s helped me most is staying grounded in something larger than the job itself. For me, that’s faith and family. My church community has been a place where I can let down the armor and reconnect with why I do this work. My wife and children remind me that life exists outside of the hospital walls—that there’s joy, love, and purpose beyond the next shift.

And honestly, music helps too. I play the guitar, and I find that strumming a few chords after a hard day does something good for the soul. It reminds me that healing isn’t only something I give to others—it’s something I need myself.

The Work Is Worth It

Despite all the stress and fatigue, I still love this work. I still believe in the power of being present in someone’s hardest moment. Balancing grit and grace isn’t easy, but it’s possible. And when you get it right—when you bring both strength and compassion to the bedside—you remember why you chose this path in the first place.

Emergency medicine will always be intense. There will always be nights when you’re pushed to your limit. But with a steady hand, a kind heart, and a grounded spirit, it’s also one of the most meaningful ways to spend a life.

And that, to me, is worth every minute.