The fabric of our profession is sometimes lost in daily routines — but there’s nothing ordinary about it. As this new year begins, I’d like to take a moment to recognize – and thank – the many distinct groups which make our specialty work.
The fabric of our profession is sometimes lost in daily routines — but there’s nothing ordinary about it
I had just placed my coffee cup down and paged the Spanish interpreter to assist with my first patient in the ED when my cell phone lit up. “Hmmm, Florida — probably should answer it,” I thought. “Hello, Dr. Wolfe, an unfamiliar voice said, “this is Dr. Krems. I’m an emergency medicine doctor.”
At this point I still wasn’t fully paying attention as I was half-expecting a reference request for a graduating resident, but then the doctor at the other end of the line continued. “Your father just came in. He’s having a STEMI and is headed off to the cath lab.” My world suddenly stopped. This was just two days before Thanksgiving and several hours before a major New England storm was expected to hit. Two hours later – with the help of some incredible coworkers, a husband with a credit card, and a teenage daughter with uncanny packing abilities – I was in a plane on a tarmac heading south.
My dad has always been a charismatic, larger-than-life sort of man, so I was unsure of what to expect when I got to the hospital. I was incredibly surprised when I walked in and saw him nonchalantly tapping away at his Kindle. He looked at me sheepishly, like the geriatric version of a five-year- old in a time out, and said matter-of-factly: “I’m fine! Literally the minute that second stent went in I felt not 100 but 1000 percent better. Now when do you think we can go home?” I finally exhaled.
Having exhaled, it was time for reflection. My dad is the new poster child for the saves we can make when the complicated systems we develop actually work. Thanks to the well-oiled efforts of EMS, ED staff and the cardiac angioplasty team, my dad went from the brink of needing paddles to looking like he was ready to walk 18 holes – in a time span that would have been simply inconceivable just 15 years ago. This was truly one heck of a Thanksgiving blessing for my family.
The next day I brought a box of chocolates to thank the ED team and the doctor who had called me. The small department – almost cozy compared to my cavernous 90-bed academic department – was both foreign and incredibly familiar. I immediately felt this deep sense of kinship. I didn’t know their layout or their EMR, but I quickly recognized the delicately choreographed dance that all EPs unknowingly master. It’s that unique and quirky ability of being able (amidst endless distractions and barely reigned in chaos) to constantly shuffle and then redirect our focus to that next critical task. Call it what you want — the ER ballet, hip hop, jig, whatever — but this is the core skill that allows us as a specialty to simultaneously manage so many human beings in distress.
This got me thinking about the whole EM network and how there is a broader connection weaving our entire specialty together. As this new year begins, I’d like to take a moment to recognize – and thank – the many distinct groups which make our specialty work.
We owe a tremendous amount to the group of physicians like Nancy Auer, Peter Rosen, Sandy Schneider and Bruce Janiak who were among EM’s early bushwhackers. While trying to make emergency medicine a legitimately accepted specialty, these early pioneers weathered more unforeseen obstacles and predators than Dorothy and Toto (though it is rumored that both groups may have encountered some flying monkeys). Many of the things we now take for granted, such as academic department status and residency training programs are the result of their tireless efforts.
These are the people who are the natural teachers and mentors. They may be our program directors, chiefs, research mentors or just that person who you are so relieved to see working in the other pod when you have a puzzling case. They are the ones who show us new tricks and teach us new lessons. They inspire us to become better doctors, leaders, spouses and parents.
These guys have expanded our learning options way beyond traditional textbooks, journals and lectures. Free Open Access Meducation (FOAM), through its podcasts, videos, tweets and blogs, truly is a game-changer. It not only caters to different types of learners (i.e., visual versus auditory) but also provides increased flexibility as to where and when we choose to learn. With a smart phone and a good podcast, long commutes or an hour at the gym can now be transformed into effective learning opportunities. For a taste, check out Michelle Lin’s Paucis Verbis cards and a list of free EM podcasts on Life in the Fast Lane.
For the record, I am not being insensitive; NERDS stands for the New England Emergency Medicine Research Directors. Our specialty has been blessed with smart people who are dedicated to studying practical questions that directly impact patient care. We owe a lot to our researchers like Manny Rivers, Michele Biros and Jeff Kline. Their high quality work is even more impressive because, historically, EM research has often been overlooked by traditional governmental funding sources.
This group is always asking, “how can we do this better?” These men and women dream up and then physically create better ways for us to take care of our patients. They are the ones who brought us the FAST exam, the finger thoracostomy and the NO DESAT model. Great examples of innovators include Rich Levitan and Scott Weingart for their work in revolutionizing the way we manage difficult airways.
The Debate Team
Our specialty began with a bunch of rag tag doctors rooting for the underdog, so it’s refreshing that we haven’t lost that fighting spirit as we’ve matured. Thank you to our colleagues like Jerry Hoffman, Rick Bukata, Ashley Shreves and Anand “Swami” Swaminathan who constantly challenge us to keep asking the hard questions in the face of industry pressure and potentially biased research.
The Story Tellers
Sometimes the contextual nuances of a work story can get lost in its translation if we try to share it with those who have not personally traveled down an EM rabbit hole. So thank you to writers like Mark Plaster, Greg Henry and Graham Walker who expertly lasso those seemingly elusive EM experiences and somehow harness them into words that we all just “get”.
The Political Junkies
Regardless of our feelings about healthcare reform, it is crucial that we as a specialty know the rules of this new legislative game to advocate for our members and our patients. Thank you ACEP and NEMPAC for reading the fine print and representing EM interests at the national level.
For years EPs have labored under the cowboy-like expectation that if something bad or difficult happens on the job we will simply suck it up and move on without talking about it. Fortunately there is a new generation of EP “coaches” – like Cliff Reid, Vickie Brazil and Rob Orman – who frankly discuss how to approach and survive the inherent stress and cognitive uncertainties of practicing emergency medicine. Thank you, thank you, thank you.
I’ve saved the best for last. These are the wingmen and women that have our backs. They are the ones we text after a bad day or have coffee (or beer) with to get confidential advice. Each of our posses is incredibly unique and likely consists of an assortment of individuals whom we have collected over our professional careers — a friend from residency, a trusted colleague, or that person we clicked with at a national conference. These are the folks that give us the resiliency to practice EM over the long haul.
Of course this list could scroll on and on to include administrators, schedulers, wellness gurus, and many more. The take home message, however, remains the same. Every time we go in to see a patient, we are taking a little bit of all these different groups along with us. And even if we work in single coverage, we are never truly practicing all alone.
So this is the New Year’s resolution I’m making – and hope you all will make with me. Recognize every day that we owe a debt of gratitude to the complicated, mesmerizing tapestry which we call the emergency medicine team.
Jeannette Wolfe, MD is an Associate Professor of Emergency Medicine at Tufts School of Medicine’s Baystate campus.
Photo by Colm Britton