“Code Blue in the waiting room!”

As my co-resident, attending, and I sprinted down the hall, I vividly remember thinking to myself that I probably shouldn’t be here right now. I was working upstairs in the surgical ICU. On a particularly slow overnight, I decided to head down to the ED to visit some friends.

Seconds later, my attending was riding the stretcher (which is never a good prognostic sign in my humble opinion) placing the patient in the recovery position as my co-resident and I were wheeling as fast as we could into one of the resuscitation bays. In the waiting room, we had met an elderly lady sitting in a pool of blood, without any clear mental status who subsequently began to vomit.

“Max, prep for intubation” my attending roared as nursing began to get vitals and place the patient on the monitor. “Pressure is 80/palp!”

Given that I was “extra” staffing, I decided to help set up the airway with my co-resident. Truthfully, I was just there for the courtside seats. “Let me know what you need, Max.”

First peripheral line placed. Blown. PVL two placed. Blown. PVL three placed. Blown. Though the patient’s blood pressure was barely palpable, I assure you that the tension in the room was rapidly trending in the other direction. “Sanjay, place an IO and then drop a femoral line!” We eventually obtained access. Resuscitated. Intubated. Arterial line placed. And then all took a deep, bated breath.

As I reach the halfway mark of my training, I’ve become more and more reflective over my progress as a resident. I’ve been trying to figure out where I am, where I should be, and how I can get there. I remember realizing very early on in training that this job is nearly impossible; the scope of practice is far and wide. I am very well aware of my deficiencies: every rash is still “maculopapular,” it still takes me at least two minutes to find the power button on the slit-lamp machine, and I still blow the occasional EJ.

We all fear it – to be ill-prepared; to not know what to do when your back is against the wall. I think a lot of our motivation as emergency physicians stems from the “nightmare” scenario.

As a trainee, I’ve found that it’s incredibly difficult to track one’s growth. It’s particularly challenging to see how far you and your co-residents have come since intern year. In-service exams only capture so much and formal evaluations occur pretty infrequently. The fact of the matter is, you are your biggest critic and constant self-examination is the only way to continually grow in medicine. But there are moments in training that will test your boundaries. And in those moments, you’ll appreciate how far you’ve come.

It’s especially moving when you see your co-residents step up and deliver. After our debrief, one of our attending’s made an interesting point: emergency medicine residency is funny in that you rarely get to work directly with your classmates. But those are the very same people who you want passing you the ET tube when the s*** hits the fan.

It’s often said that there are three types of doctors who pursue emergency medicine: the missionaries, the adrenaline junkies, and the fools. I’ve come to learn that the best ED physicians are often all three.