In the Arena: I'll Never Forget
If you practice emergency medicine long enough, you begin to accumulate a handful of experiences that you will remember vividly until life's end. Some are outrageously funny, some are touching, and others overwhelmingly tragic.
When I practiced in New Orleans, I took care of a young guy who had been injured in a minor motor vehicle accident. He was a very pleasant fellow who joked with us as the nurse and I did our assessments. We stood on opposite sides of the cart. As the nurse and I tugged off his dirty jeans, his multicolored Scooby Doo underwear was revealed. The nurse and I looked at each other and simultaneously, in our best Scooby Doo voices, said, "Rut Row." The patient loved it. I'll never forget that story.
Several years ago, while working in a small rural ED, I cared for two young siblings who were fatally injured in a senseless accident. The flood of emotions and the stress of conducting simultaneous pediatric resuscitations were wicked. I knew the children would die, but before stopping the resuscitation, I talked to the parents and asked if they wanted to be with the children before we stopped. They accepted this offer.
Before we went in the room, the mother asked if we had a minister who could baptize her children. We did not. One of the nurses told us that anyone can baptize, so the mother decided that she would do it. We put a towel on a Mayo stand and filled a basin with sterile water. She baptized them and then we stopped the resuscitation.
Normally we have little to offer families but sincere condolences, but for this family we gave them a chance to do something profoundly meaningful in the midst of unfathomable circumstances.
I've thought about that day of wonder many times. I have beheld scores of deaths, yet none are more memorable than those. I've seen thousands of funny events in the ED but it's the Scooby Doo story that I frequently retell.
Ages and strange circumstances may be part of why we remember things, but I believe that certain events stay with us not because of the events themselves but because of what we do in response.
For most people, an emergency visit is a rare event so it is memorable for them. People remember their first stitches or how uncomfortable it was to be on the backboard. For us even the big traumas and complicated medical cases usually drift to a corner of our memory.
It is when we do something unique or beyond our usual duties that events are made more memorable for both physicians and for patients. And it is the times when we are most busy that these opportunities usually present themselves. Taking some extra time to do something special for a patient can bring a rich flavor to what can become a menu of one bland experience after another.
Suggesting to a family to cut a lock of hair when someone dies is a nice gesture. They might not think of it until it is too late. Offering to call the parent of a college student who is away from home can go a long way to easing everyone's anxiety. Just sitting down, holding the hand of an elderly person, and having a conversation about what they did for a living can make their week.
Patients and their families may seem wrapped up in their problems but they do pay attention to what we do. They appreciate it when we ask if there is anything we can get them. They won't tell you but they will tell a family member or friend of your caring demeanor. They really like it when we fluff their pillow or bring a warm blanket and tuck it in around them. Some doctors may say such things are beneath them and they have more important things to do.
I say these are essential offerings in our interactions with patients. Anything we do that causes the patient to hold us in higher regard is well worth the little bit of extra time.
A traditional lament of emergency physicians is that we have no pre-established rapport with our patients. This is true but it is not an excuse for failing to do a few simple things to establish trust with our patients. When we act relaxed even though we are rushed, practice common social courtesies, and actively listen to our patients, they will notice and in turn this will lead to trust.
You may not get immediate feedback but your efforts will not be wasted. You will know that you have done a good job in the past when the lady you saw for biliary colic returns with an ankle sprain and smiles when she sees you. "I think you took care of me before I had my gallbladder removed," she says. "I'm all better now!"
You'll be better as well.
Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.