Eight years ago, my family and I returned to live in the small village in which I was raised. It was, and still is, a spectacular place to live as an adult or a child. Growing up, our family home was not particularly large or impressive, and when all five kids were home it could get crowded. Prime bathtub time was scarce. Something that was not scarce is a bunch of great memories.

I carry a vivid memory of walking around the block one evening under towering cottonwoods to the home of my sister’s best friend to watch color television. The Barnums were an equally large family that lived in a house not unlike ours. We crowded into their den, and I found a spot on the floor in front of a plaid couch. The memorable event that evening was the television showing of “The Wizard of Oz” for the first time in color.

In the mid 1960s, of course, there was no videotape, and the stations did not replay old movies endlessly. If you wanted to see “The Wizard of Oz,” you had one chance a year. I would anticipate this movie for weeks and was nearly wetting my pants the day of the showing. I can still recall how scared I would get when the witch’s guards walked in step, chanting loudly in deep ominous voices.

I still love that movie because of the music, the imagery, and the message. I recalled one of the final scenes recently after an unusual patient encounter.

About 3 years ago, I cared for a fellow villager who nearly died. While I played a key role, I certainly did not singlehandedly save his life. His large family, however, will forever credit me with his survival. Because you and I get blamed for all sorts of things that are not our fault, I don’t feel bad about taking credit for something that was not completely my doing.

So, when I cared for this man’s aunt last week, she was reminded by family members that I was the one who saved her nephew. The instant rapport I had with this family made my job much easier and enjoyable that day.

I thought about how it must be nice for the primary care doctors, who see people grow up and grow old, to have this kind of interaction with people on a regular basis. And then I thought about that scene in “The Wizard of Oz” and wondered, What do they have that I don’t have?

When the wizard has been revealed, and he must make good on his promises, he brings out a big bag. He tells the Tin Man that he is no different than the good-deed doers the wizard knows back home. “But they have one thing you haven’t got: a testimonial.”

He gave the Tin Man a large heart with a ticking clock and said, “And remember, my sentimental friend, that a heart is not judged by how much you love, but by how much you are loved by others.”

Sometimes I feel like emergency medicine is the Tin Man specialty. Our commitment and our capacity for caring know few boundaries—yet at times I feel an emptiness, or that feeling of being the outsider looking in. I think that often what is missing is that affirmation from patients and their families.

In New Orleans, a man brought me a bottle of Dom Pérignon for intubating him when he was in heart failure. This was a wonderful gesture, and I still have good feelings about it today. That kind of positive feedback and sign of appreciation, however, is rarely seen in our specialty.

This doesn’t mean that people don’t appreciate what we do. They just don’t have an easy way to do it. If we saw people in follow-up in the office 2 weeks after reducing their dislocated shoulder, we would get lots of smiles and pats on the back. The smiles we get in the ED are usually related to the conscious sedation.

We are like the Tin Man in the sense that we forget the good things we do every day and fail to realize how much we are appreciated. The appreciation may go unstated, but I know that patients and families have good feelings about us. We are loved, and the fact that our good deeds don’t accumulate in a small number of people who come to visit us again does not diminish our virtuous acts.

Stand tall. You don’t need a testimonial to hang around your neck. Your testimonial is the patients who come in severe pain and find relief, the child who experiences suturing without fear, the homeless man who finds comfort and understanding, the families who find a strong shoulder to lean on in their worst grief, and the elderly woman from the nursing home who is treated with the same care and respect given to a baby.

Threatened payment cuts, overcrowding, H1N1, and looming reform loiter at our doorstep when we come to work each day. Our jobs are not getting easier, but I know you are up to the task.

Your big hearts and broad shoulders will help you to persevere in the indispensable work of emergency medicine.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcomed at David.Baehren@utoledo.edu.