Lessons From My Last Hospital

When you work with a team of great people for several years, you grow together. You learn together. You succeed and fail together. I had the opportunity to be part of such a team in the ED for the past several years. Recently, I moved to a new hospital, which has given me time to reflect on the team I was part of for so many years.

It was my first gig after residency. When I interviewed for the position almost five years ago and walked through the ED, I could tell it was quirky place. There’s a feeling you get when you walk through an ED. Everybody can feel it. It either feels like things are running smoothly or it doesn’t. There’s no mistaking it. Surely it can change hour to hour, but that’s beside the point. Every ED has its own feel. And this place felt … quirky. 

Over the next few years, I found out just what that quirkiness was all about. It was about figuring out what a patient needed most, and then figuring out a way to actually make it happen. Knowing what to do is often – not always – the easy part. Making it happen is a different story. And making it happen was when things really seemed to get quirky.

But I had some amazing colleagues: Nurses who were overwhelmed, yet still managed to help with getting another EKG or drawing labs on a patient on the other side of the ED; technicians who anticipated what needed to be done and brought me information that I had yet to ask for; and unit secretaries who seemed to perform magic in getting the right people on the phone for me at the right time. In the face of limited resources, we developed workarounds. We innovated. We sidestepped and regrouped. We took care of patients, while taking care of each other. Some of us even took bathrooms breaks once in a while!

The evening of my last shift seemed to be like every other evening. But it wasn’t. It was the last day of my second residency. After spending more than four years there, I was a different physician and a different person. It seemed like anything could happen – and did happen – at any time in that ED.

In those four years, I got close with fear. Initially, I’d run from it. But I learned that running from fear is like running from your shadow. You can run for miles and never advance an inch. The first time emergency physicians come face-to-face with that professionally is in residency. It’s obvious then. The last time we face it is … never. It never completely goes away, although it can become harder to recognize. Fear becomes more subtle as we become more competent, more experienced, more professional, and more human.

The best leaders are those who recognize and manage even the subtlest expressions of fear, both in themselves and others.

As my last shift wound down, I said goodbye and thank you to the team. It was the culmination of a slow, month-long goodbye. Amidst hugs and smiles, sadness hung in the air. It wove through the silence between our words. I expressed my gratefulness as best I could, unable to package exactly how much I had learned. There are some things you can never pay back.

I still pass that hospital now on the way to my new gig. It makes me smile. That was my second residency. I’m now an intern in my third. I’m still learning.