Matthew Tanzi, MD
Welcome to the Organized Chaos: Advice for New Interns
*Outside of emergency medicine, it is difficult to find another specialty that relies so heavily on teamwork. Thrown in to the fire from day one, you will discover that the emergency department moves fast and is entirely unpredictable. You will undoubtedly be a hot, anxious mess, miss the subtleties, or have someone (likely a nurse) bring your attention to a situation that is about to develop. To that extent, it is essential to learn the names and roles of the people who you will be working alongside in the department. Introduce yourself to the nurses, aides, radiology techs, support staff, social workers, and housekeeper. They are the backbone of our department without whom the department cannot function. More importantly, they will save your butt more times than you will be able to count.
"Hey doc, are you sure you want ten grams of potassium and not ten mEqs?"
"Oh-My-God please just 10mEq. I can't have anyone dying on my first day! "
"Hey, I knew you were busy and I didn’t want to interrupt you but I went ahead and did a rectal temp in room five and its 39.6C… soooo do you want some Tylenol and maybe some antibiotics and even maybe some fluids? :)"
You will encounter a mix of old versus new school philosophies regarding the science and art of emergency medicine. Over time you will be able to develop your own blended practice. Recognize that there is always something to learn from each person. Specifically, the nurses, who encompass our front line and see everything that we do not. When they come up to you concerned, you better take heed and respond.
Clean up after yourself, especially after a procedure. Do not leave bloody supplies, sharps, and weird body fluids untended. The housekeeping team will appreciate you. We cannot thank them enough for what an amazing job they did during COVID-19 crisis. They keep us safe.
If you need an EKG but see that there’s only one CA in your zone and that they are doing a million tasks, do it yourself! Even more, let them teach you how to do it! If you see that they are having a difficult time with a 1:1, get up to help! Make them laugh or bring them a snack or a drink – because who doesn’t love snacks? And also, hypoglycemia is very bad. Most importantly, do not forget that they are humans too. I bet you have a lot in common with them. Show them that you are A REAL, COMPASSIONATE PERSON and not a chart grabbing machine! And when you leave, whether it was the best shift ever or the worst of all time… smile and thank them for everything that they do.
*Have compassion and empathy. Leave your ego at the door. We are all all on the same team and have the same goal – to provide the highest quality patient-centered care. Remember that it is an absolute privilege to be where you are and do what you do. People come to you for help, not judgment. Regardless of the chief complaint, as petty or stupid as it may sound, patients are coming to the hospital for your care because they believe that they are having the absolute worst day of their lives. Each patient has their own story, and treatment plans or diagnoses cannot be made without a comprehensive understanding of the individual. The ability to combine these entities ensures that the humanity of the patient is not obscured in a jungle of lab results and paperwork. All together, this enables us to understand the ‘why’ and ‘how’ behind the patient and presenting disease, rather than just the ‘what’. Remember, patients will recall everything you say and do.
*Never lie, know your limits, and ask for help. You are about to start day one of the rest of your career which will be encompassed by endless learning. At no time will anyone ask you to recite Chapter 17, paragraph 2 from Tintanalli’s. What will be asked of you is self-awareness. In the beginning, you will not know the answers to many questions or the best management. Some patients will be an absolute blur. But do not let that stop you from learning. Ask questions and do not be afraid to say “honestly, I have no idea… can you explain it to me?" or "Why did you decide to do this?”
Of even more importance is honesty. If you lie, you will inevitably be caught. You are putting patients' lives at risk and it is just NOT WORTH IT. No one is here to judge you when you make a mistake. Remember, this is your job but you are also training. Mistakes will happen and that is ok! You might miss an intubation, forget to order antibiotics, or neglect to call a family member. Take responsibility and look back on the case and see what you could have done differently. Learn from the situation and try not to let it happen again. Will it be embarrassing? Maybe, but not to your seniors or attendings; I can guarantee you that we have all been in your shoes.
*Physician wellness is an underrated, but essential, part of emergency medicine. Studies have shown that almost 75% of medical students and resident physicians are on anxiolytic or anti-depressant drugs. In fact, I’ve seen a therapist and have taken medications and I am not ashamed to say that. Our system may consider this a red flag, instead of a positive signal that I’m taking the best care of myself. In that regard, things need to change, and I hope that occurs in due time. It takes a great deal of courage and strength for a person to realize that they may need support. No one needs to feel like they’re drowning, or even treading water, just to stay afloat.
Real life from just last year: Imagine that you have just coded a middle-aged male found unresponsive in his car at work. Unfortunately, he dies after an hour of intensive resuscitation. Afterwards, you discover that he was the father of three young girls as you see his wife walk by in tears. It is incredibly heart breaking. No one expects you to just wash your hands and move on to the next patient. It is okay to take some time, debrief with your colleagues, and go outside to collect yourself. Honestly crying is not a weakness but rather, it is a reality. Feeling emotion means you’re human.
Make sure to reach out. The resources are endless, and we’ll get you to the right place. I know it usually takes a nudge to actually get to that point but we can help you. Our specialty may emphasize "moving the meat" and grabbing the next chart on the rack, but that does not mean that it has to come at your own expense. All of this is heightened in our current era, where COVID-19 has forced necessary isolation and a dearth of distractions, which comes with widespread neuropsychiatric consequences.
Do not forget that you are still a person. You still have a life. You still have families and friends and hobbies. Take time for yourself in whatever way you choose. Go to the beach with friends in the summer or ski upstate in the winter. Read a book at sunset or just sit there and reflect at sunrise. Go to breweries or wineries, play with your kids or fur babies, and make time for your significant other. Work out, do yoga, run, make a delicious meal, listen to music, or watch something mindless on Netflix. No matter what it is, find your happy place.
We are lucky that emergency medicine allows us to work a predetermined number of hours and then leave it behind to go home. When you are at work, we expect you to work. But when you are off, focus on you. Hold yourself to a healthy work-life balance. It will not only make you happier and promote a better sense of self, but it will also make you a better doctor.
Matthew Tanzi, MD is a PGY-3 Administrative Chief Resident at Stony Brook Emergency Medicine. He can be found on Twitter @mtanzi2791.
Larkin GL, Beautrais AL, Spirito A, Kirrane BM, Lippmann MJ, Milzman DP. Mental health and emergency medicine: a research agenda. Acad Emerg Med. 2009;16(11):1110-1119. doi:10.1111/j.1553-2712.2009.00545.x
Stehman CR, Testo Z, Gershaw RS, Kellogg AR. Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I [published correction appears in West J Emerg Med. 2019 Aug 21;20(5):840-841]. West J Emerg Med. 2019;20(3):485-494. doi:10.5811/westjem.2019.4.40970
Edited by Bassam Zahid, MD
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