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• W4309173635 abstract "Forty-nine days into my intern year in emergency medicine, and I am slugging through my first rotation: trauma surgery. Each day is filled with the same tedium of placing orders and tending to patient’s social work needs. Colace, Senna, start antibiotics, get Mr. Jones discharged. Rounds with the residents, rounds with the attending. Respond to pages, go to trauma codes, ask for help when needed. Until I was on my own. One of our patients, who I will call Mike, sustained a spinal cord injury after a terrible motor vehicle accident. Most of his body was paralyzed, but he maintained some use of his arms. He would be able to speak, but his new tracheostomy tube prohibited it. Each day during rounds, I intentionally say hello and help him with menial tasks. I feel for him—here was a young man discovering that he would never walk again, who spent his 21st birthday bedridden in the ICU, and who could barely have visitors because of hospital-wide COVID restrictions. At times, I feel reassured knowing that I can (hopefully) make his days a little brighter each time I give him a fist bump or help him set up a movie. Other days, my heart breaks thinking of the devastation of his accident, projecting on him my own feelings of loss. Empathy serves as an asset to a physician, but it can crush the spirit too. I am on my last night of call when I receive a page about Mike: “…Patient feels like he is going to die…” His nurse explains that Mike is becoming increasingly tachycardic and short of breath. Although he had recently become septic from a UTI, the ominous wording of the text leads me and my senior to order a CT scan to ensure that a pulmonary embolism was not contributing to his clinical deterioration. As I watch the images pop up, we realize Mike is moving too much for an adequate study. I calmly ask him to remain still, but he is having a coughing fit. I attempt to suction him without success. Meanwhile, the nurse tells me that his heart rate is dropping, now only in the 50s. As I look into his panicked eyes, assuring him that everything will be alright, his face goes still. I look at his chest and see no movement. “He isn’t breathing. Where’s the BVM?!” I shout. The nurse points to the crash cart across the room. “Get a doctor, I’m only an intern!” I clumsily remove the attachments to Mike’s trach and connect it to the bag-valve-mask device. When I reach down for a pulse, I feel nothing. “We have to start CPR, get on the chest!” I yell with fabricated confidence. Thirty eternal seconds of compressions and, finally, an attending physician and a coresident appear and palpate a pulse; we stop CPR and transport Mike into the resuscitation bay. My heart is racing. As I look for a central line in a distant trauma bay, my adrenaline drops. Fear threatens to unravel me. Big breaths. Eyes blurring with tears. A brief reprieve of horror from the thought of losing Mike with momentary catharsis. But this is not the time to unpack my feelings of terror or disappointment in myself. I might only be an intern, but I have a responsibility to fulfill. Inhale. Resorb the tears. Get back into the chaos. I am met with the kind and familiar faces of my colleagues. I laugh off the frenzy of the situation, concealing the panic I had just endured. I can finally let go of the weight of responsibility now that the patient is in the better hands of more qualified physicians. When 8 AM signals the end of my night on call, my eyes are glazed over, burning from lack of sleep. I fixate on my mistakes, ruminating on ways everything could have been worse. Did I do something wrong? Why did I not prepare for this better? Most importantly, is this what my new job will always feel like? Study and practice helped me know the essentials of resuscitating Mike. More experience might have helped me think through the worst-case scenarios and be prepared for a crashing patient. But I am convinced that nothing could have equipped me for the first time I was truly responsible for another human life. Nothing could have prepared me to know what it feels like to first become a doctor." @default.
• W4309173635 created "2022-11-24" @default.
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• W4309173635 date "2022-12-01" @default.
• W4309173635 modified "2023-09-27" @default.
• W4309173635 title "Get a Doctor" @default.
• W4309173635 doi "https://doi.org/10.1016/j.annemergmed.2022.09.023" @default.
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