Nobody becomes a pediatric emergency medicine doctor because they think it will be a relaxing or an easy way to make a living.

About 35,000 patients a year seek treatment in the Pediatric Emergency Department at Johns Hopkins Children’s Center — between 60 and 160 a day. They arrive around the clock, a cross-section of young people, from newborns to 21-year-olds, in just about every state of duress it’s possible to imagine.

Caring for these patients is difficult, important work. It requires an almost supernatural ability to radiate warmth and calm in even the direst moments.

“I think many of us like the fast-paced environment,” says Pediatric Emergency Medicine Director Leticia Ryan.

With each patient, these doctors must quickly gather information and decide next steps. That could mean ordering more tests, consulting with specialists, finding an inpatient bed for continued care, comforting grieving parents or simply affixing a splint to a child’s broken finger.

“I can’t imagine doing anything else,” says Raquel Millet, a second-year pediatric emergency medicine fellow.

Here are some of the qualities that make Johns Hopkins pediatric emergency medicine physicians so good at what they do.

1. Empathy

Julia Kathleen “Kate” Deanehan has a way of walking into a room and putting patients and families at ease. “I heard you hurt yourself yesterday,” she says to a child with a minor injury. To a sicker patient, describing her pain, she says “Oh, I’m so sorry,” almost under her breath.

“No one wakes up and thinks they're going to end up in the Emergency Department that day,” says Deanehan, who has been comforting and treating patients and families in the Children’s Center since 2013, the last two as director of pediatric emergency medicine clinical operations.

“You’re meeting people who are often in very stressful situations,” she says. “Sometimes we’re treating a minor cold, but sometimes we’re giving a life-changing diagnosis. It’s important to really try to connect with someone you don't have a background with or a history with, and in a very short time frame.”

Millet always attaches a small, colorful toy to her stethoscope, a Baby Yoda doll or Mickey Mouse ears, whatever she finds at Target. They distract her young patients, she says, and shows that she likes toys too. “It’s important to be approachable,” she says.

2. Communication Skills

As Deanehan and Millet make their rounds, they focus on the patients and their families, not on their computer monitors. Only after the visit do they circle back to their workstations to update electronic medical records.

Communication skills are essential in a job that requires constant gathering and sharing of information. Pediatric emergency medicine doctors listen carefully to patients, parents and grandparents who may be having the worst day of their lives or are experts in their little one’s chronic disease that has brought them once again through the Emergency Department doors.

It’s not enough to ask a patient with cystic fibrosis if she’s having trouble breathing. Deanehan wants to know when the problem started, where it hurts most and if the IV in her arm is uncomfortable.

Communication skills are also essential for interacting with a changing roster of nurses, specialists, residents, fellows and others, all with the same goals but different levels of experience and expertise. With each shift change, the doctors who are leaving give detailed updates on the pediatric patients who are staying. 

“A huge part of what we do is talk with other clinicians,” says Millet.

3. Knowledge — and Humility

Pediatric emergency care doctors at Johns Hopkins know a lot — including how much they don’t know. “Every other shift, I see something I haven’t seen before,” says Millet.

They treat everything, from common colds to rare genetic disorders, from happened-in-a-flash traumas to long-simmering chronic illnesses.

“We touch probably every specialty in the hospital and know concentrated bits about each one,” says Deanehan. “We might not know the details of a rare hematology diagnosis, but we know how to take care of an oncology patient who comes in with a fever.”

As the only accredited pediatric trauma and burn center in the state, the department draws severely injured patients from hundreds of miles away. And as Millet notes, treating kids from birth to age 21 means she has to know what’s normal and what’s not for every age group. 

“If I see a heart rate of 130 or 140 in a newborn, I’m not worried at all,” says Millet. “If I see that in a 16-year-old, they could be very ill.”

That’s why it’s so important, she says, “to recognize what I don’t know.”

The emergency doctors consult frequently with specialists and use point-of-care medical information resources like UpToDate to fill in knowledge gaps on the fly.

4. Sustained Energy for Multitasking

Shifts are so busy that doctors rarely find time to eat or even use the bathroom. “I keep PowerBars in my pockets so that I can eat one quickly,” says Deanehan.

New demands pop up constantly.

Emergency medical technicians call to say they’re on their way and to share what they know about the patients they’re transporting. Officials with Child Protective Services bring children in for evaluations. Pediatricians and specialists call with questions or to say they’re referring a patient.

“There’s a lot of juggling, and you’re constantly being pulled away from what you’re doing,” says Deanehan.

More than the physical exertion, though, is the stress of constant, high-stakes decision-making. “You’re making decisions for eight hours straight, and you have to make them quickly,” she says. “I’ll come home, and my husband will ask what I want for dinner, and I’ll say I just can’t make another decision. The decision fatigue is real.”

5. A Sense of Humor

This may be the most important quality of all, the physicians agree. Laughter and jokes forge connections, put serious situations in perspective and help everyone get through difficult days. 

Recently, Millet checked on a patient with a seizure disorder. The child, who wasn’t particularly verbal, suddenly announced, enthusiastically, that he wanted a certain fast-food treat.

Tension in the room disappeared as Millet and the child’s parents burst into laughter. The patient, clearly pleased with the reaction, said it again, even louder. 

For a moment, the swirl of activity and the relentless push for information and decisions stilled, as the adults in the room simply delighted in a child’s happiness.