There are few places like an Emergency Department. No length of formal training can completely prepare you. You will never have the depth nor breadth to know everything that you are required to know in order to care for the patients in front of you. Where would you find educational instructions on how to remove a metal water bottle that has been stuck on a patient for three days after he decided it was a good idea to insert both his testicles and penis in the narrow-rimmed opening? No textbook details this type of removal. The training includes specifics of “if x then y,” so there are clinical algorithms to learn and apply. But you also learn very quickly that patients rarely fit very neatly into little boxes and clearly in pathways. Rather, they are complicated. They have comorbidities, coexisting significant diseases that impact treatment plans. They fit in the algorithm to anticoagulate for their cardiac condition, but they have an alcohol use disorder and are at risk of intoxication-related falls. They meet criteria for replantation but have to get back to work to support their family so prefer the revision amputation. The examples are endless and perhaps more common than the textbook norm.