It’s the Simple Things that Make All the Difference

Humility is one of the great virtues of an ER doc. As many of us know we work in a fishbowl and there is no shortage of armchair quarterbacks ready to point out all we did wrong in caring for a patient. That never bothered me very much as I take comfort in the fact that I am here at (pick a time of the day, night or holiday) while most people are at home with their families. It’s the life I chose to lead and that’s okay. 

Sometimes it is the daily grind which gives us our shining moments to remember. Other times we can be surprised by what, in our estimate, we thought was a ‘great save’ that turns out to be a less than pleasant reception by members of a patient’s family. One of the other great things about practicing emergency medicine is you never know from what quarter the praise or criticism will emanate. I guess it’s one of the things which keep us on our toes. It was such with two patient experiences I had while working my last few shifts.

The first patient was an elderly woman who had a complication at an outpatient center and was being brought to the ED by EMS with respiratory distress and an inability to intubate in the field due to excessive vomiting. It was one of those cases ER docs all fear; a difficult airway that had already been made more challenging by repeated attempts at intubation. So we do what we do. I spoke with the nursing staff and got the team ready. We broke out our difficult airway kit, video laryngoscopes and prepared for the worst.

As the patient arrived she looked very bad. She was grey in color, sats of 90% on 100% oxygen with respirations being assisted by EMS. Not having much time I asked the nurse to push the drugs, had the respiratory therapist do cricoid pressure and prayed! First look was as expected, lots of vomitus in the airway. After a bit of manipulation the endotracheal tube found its way into the trachea. Sats came up nicely and patient began moving around purposely and required sedation. Sounds like the definition of a save to me!

A few minutes later I asked the charge nurse if any family had arrived with the patient and she said she thought someone was in the waiting room. I asked her to be put in the family room so I could speak with her. A minute or two later I headed to the family room and was met halfway to it by the patient’s daughter standing in the hallway glaring in my direction. I introduced myself, asked her to come into the room and began to explain what was happening with her loved one. After I explained the situation, with the bluetooth device blinking in her ear, still glaring at me, I asked if she understood. She said she understood English and asked why I was keeping her from seeing her loved one.

In my own post catecholamine withdrawal I asked her if she realizes that her loved one nearly died (and not so indirectly) that I had literally saved her life. To which she replied that “I thought YOU said she was stable!” Well NOW she is stable but not a few minutes ago was my response. It was one of the few moments in a long time when I lost my cool with a family. At that point I told her that I was leaving to continue to take care of her loved one and I would send the nurse to get her in a few minutes when they had time.

While I understood she was projecting and stressed, how about just a small token of thanks for what I did. It would have gone a very long way. I contrast that interaction with one from my last shift this weekend.

I took care of a young man who had what appeared to be a kidney stone. We did the usual stuff; IV, pain meds, non contrast CT and after several hours he was a new man with the pain completely resolved. On leaving the department he walked over to me and extended his hand. First thing I noticed was man was he tall! I am always surprised at how much bigger patients are when they move from supine to upright. Not being a towering individual myself, some would say vertically challenged, I often find it interesting to see a patient walk out under their own power.

As he extended his hand he looked me in the eye and said, in all sincerity, “I really appreciate you taking care of me today. You made me feel better and it was obvious you cared about me”. Wow! I was sitting next to a third year EM resident who looked at me as he walked away and said that was pretty cool. It kind of makes it all worth it. Indeed it does. And that is the lesson.

In this day and age we see so much negativity and are very good about picking out all that is wrong with, well, you name it. A few positive words, to our colleagues, the nursing and tech staff with whom we work, and certainly our patients can go a very long way. I realize in the midst of all we do this is not a very easy thing. Yet if we make the effort we may find the goodness we project coming back to us in ways we can’t imagine. Just a thought.