“There are some things you learn best in calm, and some in storm.”
– Willa Cather
Over the past several years, I’ve thought a lot about what to say during the immediate moments after a failed cardiac arrest or traumatic resuscitation. When the rush of adrenaline comes to a screeching halt and all that is left is a deafening silence, words often fail me. Ashamedly, I tend to look to my attending for guidance in these moments.
After a particularly busy Bellevue overnight, one that included a cricothyroidotomy, a thoracotomy, and multiple chest tubes and central lines, I walked home that morning reflecting over the past three years of training and how things have changed. When I matched three years ago, I had dreams of doing it all – reducing joints, intubating GI bleeds, reversing life threatening DKA. And residency has given me all of that. As attending-hood is lurking around the corner though, I’m beginning to find myself more willing to embrace my weaknesses. And it’s not necessarily the science of our practice that frightens me, but the nuances and subtleties.
I vividly remember the first time I had to tell a patient that she might have cancer. It was the second month of intern year. I certainly stumbled through the conversation, but I remember holding her hand while looking at her and her daughter. In retrospect, I’m sure they felt my apprehension just as much as they felt the weight of the news. Selfishly, I hope they felt my sincerity.
Residency is filled with simulations, OSCEs, and other modalities to empower us as trainees. But there are just some things you can’t fully prepare for – like how to maintain a patient’s dignity in the silence after a prolonged but failed resuscitation. Like how to let a patient take their frustrations out on you because the world has been unjust and unfair to them. Like how to tell a patient that though you are their doctor, that does not mean you are perfect.
I believe these are the instances that define us as emergency physicians. And I would argue that more often than not, these moments require us to be more human than simply another white coat. Like many others in our field, a significant portion of my identity is defined by being a physician. This career has made me a better partner, a better friend, a better son, and overall a better human.
I am eternally grateful to have this job. Every day I am reminded of what a wonderful responsibility I have. And that is all that really matters. We are taught from day one that others will have a difficult time understanding our role – both in and outside of medicine. I can’t help but grin when every so often I get asked at a social gathering what I do for a living. And even after responding that I am an emergency medicine physician, the subsequent question is “So what are you going to specialize in?” And that’s okay. I don’t expect people to truly grasp what I do – that so much of my job is giving food to people who haven’t eaten a real meal in days or providing shelter to those who can’t manage to take care of themselves. One of my co-residents loves to say, “It’s lunch pail, pull yourself up by your bootstraps medicine.”
I won’t ever feel ready to become an attending. But I’ll continue to fake it until I make it. And one day, I’ll know what to say in the silence after.