“What’s your airway plan, Michelle?”

To be quite frank, I don’t think I actually listened to what my junior said in response. Without much thought, I promptly replied (in my big boy voice), “Awesome, I’m going to help you set up.”

Since July, I’ve been told that I’m a “senior resident.” I’ve also been told (by Uncle Ben), with great power comes great responsibility. Now that my co-residents and I have been tasked with supervising our juniors and running a team, I’ve encountered a new dimension to clinical medicine – the art of precepting. Suffice it to say, I have never been more tired as a resident. For ten to twelve hours, I am obsessively reviewing labs, looking at imaging, verifying that urine and cultures has been sent, leading resuscitations, and constantly running the triage board. It’s difficult evaluating critically ill patients; it’s even more challenging delegating responsibility and making sure things don’t fall through the cracks in a hectic ED setting when you aren’t always the primary provider.

Despite all of that, I have come to enjoy emergency medicine in a way that I never could have imagined. It’s no longer enough to provide excellent clinical care. I now feel an inherent responsibility to set an example for my juniors. I am very cognizant of the fact that I am the clinician I am today because for the past 2 years, my seniors have given me the opportunity to make mistakes, have pushed me when I needed to be pushed, and have told me that one day I can be an excellent physician (still holding onto that one).

Your attendings will always have your back. But there is something different when a co-resident pulls you aside for a procedure, stays after shift to explain management of something you don’t quite understand, or simply advocates for you as a clinician. The culture of camaraderie is one that drew a lot of us to this specialty to begin with. And now that I have enough years under my belt to pass on the knowledge that I have accrued, I’m realizing the importance of my role as not only a clinician in training, but an educator in training as well. I owe it to my juniors to help them avoid the mistakes that I once made, to be better than I was, and to foster a culture of growth.

For those of us in academia, investing in each other as colleagues is critical. And that doesn’t mean you necessarily have to be the most intelligent, the most procedurally savvy, or a great orator. But I would humbly submit that we all have an obligation to return the favor. Most of us would not be where we are today without the guidance and support of those far more experienced than we were at the early stages of our careers.

Needless to say, Michelle nailed the intubation. Walking home that evening, I had felt a sense of pride and accomplishment that I had yet to feel during residency. Overcome with gratitude (and probably the adrenaline of intubating a critically ill patient), she thanked me afterwards. But there was no need to. Just pay it forward, Michelle.

“Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.” 
― Paul Kalanithi, When Breath Becomes Air