“Just cut. He’s dead”, my senior resident calmly whispered behind me. I had walked through the crash chest tube hundreds of times in my head. I knew the steps like the back of my hand – fourth or fifth intercostal space, mid-to-anterior axillary line, cut above the rib, bluntly dissect with the Kellys, pop through the pleura, and keep your finger in the pleural space. In fact, my senior (who I shall now refer to as the Chest Tube Whisperer for the remainder of my time as a resident) talked me through the procedure just before our patient arrived to the trauma bay. I was ready – I was gowned, scalpel in hand, heart racing. But in that moment, all I could think was, “BUT WHERE IS THE BETADINE?!”
Truthfully, I might have blacked out for the next 10-15 seconds – for the next thing I remember was having my finger in this patient’s thoracic cavity. As my co-intern and I were securing bilateral chest tubes, someone roared, “We have pulses!” Relief.
I’ve never viewed residency as a job – because I don’t believe it is. I am an apprentice. My value to this program is not who I am now, but the type clinician that I can one day become. I was chosen because the next time I place a crash chest tube, I’ll be a little smoother, a little quicker, and a little wiser. The fact of the matter is, is that my responsibility doesn’t end when I leave the hospital; it means looking back at my mistakes, learning from them, and becoming that much better the next day.
And I’ve come to learn that this growth is fascinatingly subtle. It doesn’t happen overnight. There are no objective markers. But there are moments that push you. And in those moments, you will be entrusted to deliver.
During a recent multi-casuality incident, Bellevue received multiple Level-1 traumas simultaneously. Given the acuity and the volume of the situation, several of my co-interns and I were called upon to help with the resuscitations.
“Sanjay, go to the head of the bed and prepare for intubation”, my chief resident instructed. And though I had never intubated in the trauma bay, I felt unexpectedly empowered. Without thinking, the words just came. Nasal cannula. Non-rebreather. BVM. End-tidal. Two suctions ready at bedside. Mac3. 7.5 ET tube. Bougie. 100 sux. 20 etomidate. “I’m going to be first attempt, Di will be second, Christie is going to be third.”
I knew the plan. I felt comfortable. I was confident. And just as I was about to push the meds, my attending calmly walks over with a pen and marks the cricothyroid membrane. “Okay, I think we’re ready now.” (I’ll never forget that, Christie). As I remember it, what ensued in the following moments was a deafening silence. No one was screaming, “WHAT DO YOU SEE?!” Instead, the last thing I recall before starting RSI was my chief telling me that I was going to get first pass. Bilateral breath sounds. Condensation in the tube. End-tidal at 30. Relief.
Intern year is filled with innumerable emotional highs and lows. There are days when you will feel grossly incompetent and question your abilities. And there are days when everything starts to click. But I knew that was going to be the case. What I did not appreciate, were the subtleties to our training.
As I look back over the past 12 months, the most invigorating moments were when those around me placed their faith in me. The beauty of emergency medicine training is that a good portion of it is trial by fire. When time is of the essence and your back is against the wall, will you perform? When a patient’s life is at stake, how deeply humbling it is to be trusted in those dire moments – that is what I am most proud of.
To the NYU/Bellevue Class of 2017, it’s been a pleasure running Side2 with you. Thank you for trusting me.