I love sports; I’m the type of guy who opens up ESPN.com on his laptop before The New York Times or CNN every morning. I can most definitely name the last ten NBA MVPs faster than all of the PERC criteria. That being said, I am probably more parts “mathlete” than athlete. But that doesn’t mean I haven’t thought about which fellow stars would make up my entourage, the emotional underpinnings of my dream retirement speech, or my pre-game walk up song(for the record, it’s Danger Zone by Kenny Loggins).
In the waning days before July 1st, in a midst of panic, I became increasingly nervous about starting my training as an emergency medicine resident. Having not set foot in an ED in several months (shout out to fourth year of medical school), I had forgotten what had drawn me to the specialty; what did I get myself into?
Two hours into my first shift as an intern, my chief resident called me into the trauma slot after a level two activation to perform the primary survey. Immediately after forgetting everything I knew about the ABC’s (and slightly wetting myself) – I proceeded to yell, “THE PATIENT SEEMS TO BE BREATHING!” – not only in front of my Emergency Medicine colleagues, but the trauma and orthopedic team as well. Good start, Sanjay. My first bit of training as an MD was actually a few days earlier during a Pediatric Advanced Life Support class. The pediatric cardiologist who had been practicing for over 30 years opened up, “If nothing else, remember that medicine is insufferably humbling.” Point taken.
Later that shift, I encountered a patient with a tracheostomy tube being wheeled in for severe respiratory distress. Knowing that I had to oxygenate her, I began to fumble with whatever equipment lay behind her stretcher on the wall. I very quickly came to the realization that I had no idea how to provide oxygen to someone with a tracheostomy tube. Needing oxygen myself, I became more anxious as I could see my patient desatting. Like a deer in headlights, I looked to the nurse working my side and she soon scurried over to set up a T-piece – crisis averted. But I was 0 for 2.
Three weeks into intern year and I feel as though I’ve already had a lifetime of ups and downs. But my shining moment came not during placement of a difficult IV, my first lumbar puncture, or a pristine lac repair. Rather, it came in a moment of vulnerability and legitimate fear.
While working a shift with my program director one evening, EMS had brought in a young man who had overdosed on an unknown stimulant. The patient had come in agitated, incoherent, and writhing around in his stretcher. After initially stabilizing him with benzodiazepines, intravenous fluids, and obtaining the appropriate labs, I had moved onto other patients that needed to be seen. About an hour later, as I was eyeballing all of my patients, I found this same man to be rigoring, drenched in sweat, and breathing heavily. With my PD on the other side of the department, I immediately began to panic as I thought my patient was about to code. So I did what was natural – I dropped everything and quite literally sprinted across the emergency room to get my attending. I roared, “I think our patient is sick!”
When we made it back to our patient to reassess him, my PD reassured me that he was simply defervescing. Feeling like a complete fool, I slumped back to the workstation. Not two seconds later, my PD put his hand on my shoulder, looked me straight in the eyes and said, “I’m proud of you.”
Every time I step foot in the ED, I imagine a game of baseball; every shift is an opportunity to throw the perfect game – to nail every diagnosis, to order just the right set of labs, to flawlessly perform every procedure that’s needed, and to clean the board just before sign out. Not one month into this and it’s obvious that I can’t even make it past the second inning.
As interns, we get into jams frequently. But it’s important to realize that you’re never alone. As you decide what pitches to throw, you’ll always have your attending guiding you from behind home plate. Your nurses are there to help start the 6-4-3 double play. And more often than not, your co-residents are there to make a diving catch on a line-drive. There is a beautiful harmony in the ED that is unlike any other place in the hospital – an interdependence that’s both palpable and vital to the care of our patients. It’s why I love this specialty; it’s an opportunity to be apart of something bigger than one person could ever be.
Realistically, I may never throw the perfect game. Especially during intern year, I’ve come to realize that it’s about acknowledging the little victories – like voicing your concern about a potentially sick patient. But that doesn’t mean I won’t be striving for perfection. Because next time, you better damn believe I’m going to go all nine innings.