Teachers...

The life of a young doctor is riddled to the brim with ups and downs. I spend most of my time thinking, worrying, fighting with an internal dialogue over my next question, my next exam, my next order, my next anything. It is not so much that I am frozen by fear although I hold my fears close and allow them to help guide me through the valley of death. This internal dialogue rests in the realm of polar opposites. In life there are fundamentally two kinds of people: those who do and those who do not. Inherently, we slide back and forth between these two kinds of people throughout each day, a continuum of doing and not doing. Each decision between these two end points carries consequence and responsibility. So what does this all have to do with teachers? In the emergency room, there is a lot of doing especially from the young doctors who are still treading through that soupy matrix of residency. Young doctors mainly learn from three people: the patient, the nurse, and finally senior doctors. We learn the most from the patient, who trusts us to do no harm and find a way to the right decision, albeit stumbling at times. Above all, however, it is the nurse who carries my utmost respect and admiration. A nurse carries the weight of the patient care and advocacy, of teaching, and of keeping the physician out of trouble. To the resident who is about to make a mistake in ordering a drug or laboratory study, one might hear from an experience emergency department nurse to the new intern, “Doctor are you sure you want to order that lab?” There is a method in their ways. They come at you with the respect of a colleague but also with deep down seeded confidence in knowing the right answer and still offering the student, the young doctor, a chance to learn. The nurse could easily pass on the opportunity to teach and continue to go about his/her duties, but he or she doesn’t. The nurse cares not only about the patient of which he or she is responsible for but also for the young doctor. Tonight, with my glass of gentle red wine, I toast the nurse from which I will learn more than I may ever realize.

18YO M, Near Drowning

“Come with me.” I sat there for a second as the words sunk in. Then, boom back to reality. I grabbed my stethoscope off the computer station. In stride, I joined my attending physician en route to the resuscitation bay. “Your patient” echoed as we entered the room. A medic was in the room, tablet computer in hand. No pleasantries, just the facts, one after another. Mental checklist lit up like the edge of a wildfire. An 18 year old kid was rolled up in the surf, panicked, and inhaled a bunch of water. Lifeguard rescue. Okay, he’s awake. That’s a good start. He’s talking that’s even better. No distress. Why isn’t he on a backboard? Where is his neck stabilization? “Hey bud, were you awake the whole time? …Did you hit your head?” As I reached to feel his pulse, I asked “Does anything hurt?” Normal radial pulse, a little tachycardic, I’ll take it. I turned to the medic, “How was he at the scene?” Okay so his oxygen saturation was a little low at the scene, let’s see what we get here. As I inspected and palpated his body for tenderness and listened to all vital organs, I asked, “Any breathing problems right now? Any numbness, tingling, weakness? Any history of lung problems, asthma, heart problems, seizures? Can you tell me where you are? What is your name? Who is the president?” I ask again, “any pain?” No signs of trauma. Lungs actually sound clear. Oxygen saturation is normal. Patient appears to be stable. Okay, let’s slow this down. I turned to the medic, “Anything else to add?” “Thank you for your work. You all did a good job.” The attending broke the brief silence as I finished up my initial checklist, “What do you want to do for him?” “Nothing besides a little oxygen. He needs a chest x-ray and basic labs.” “Okay, fine with me. Are you going to admit him?” “Not at this time. We’ll watch him. If he stays stable and nothing turns up in any of the studies, then we can send him home.” “Fair enough.” Okay, I have to remember to add him to my patient roster. Now, what in the hell was I doing before this?