"But then there are the other times, when everything goes perfectly. You don't think. You don't concentrate. Every move unfolds effortlessly. You take the needle. You stick the chest. You feel the needle travel -a distinct glide through the fat, a slight catch in the dense muscle, then the subtle pop through the vein wall - and you're in. At such moments, it is more than easy: it is beautiful." –Atul Gawande from Complications
Recently went down to the local fair (“show” here). I keep telling people Tassie is a little like WV, where I'm from, and the show more or less proved it. It was a pretty typical fair situation, with little portable rides and toss-and-win games. But what was a little extra awesome was the agricultural flavor to it. There was a dog show that breeders came from across a few different states in Tassie. Favorites included the huskies and the Tasmanian “labra-doodles” (hypo-allergenic & non-shedding, apparently; http://www.labradoodle.com.au/ for those interested). Also ideal were the “suspend your child from bungee cords over trampolines,” the wood chopping competitions, the chainsaw sculptures, and the horse jumping (English saddle). Some of the pictures are attached.
Also, with all the rain down here, it had to happen sooner or later....
In other news, recently found out that an Attending and friend from my residency passed away. In the words of another good friend via email, “in case you haven't heard, today the ground shook.” This doc was one of the first EMTs that graduated through the NY training system, then went on to be one of the pillars of the system where I trained. No graduate from our program was untouched by his personality, or failed to tighten up their sign-outs when he was the one coming one-- and that included the grads who had become Attendings! One day I was wearing striped socks and working alongside him. Another Attending approached and asked “Did you see the guy with the shoulder?” His response? “Ask Dr. Seuss over there.” I remember in particular an episode when I was running Fast Track cases by him. A schizophrenic patient was there for unrelated complaints, but he seemed a little disorganized and distracted, though not actively psychotic. Still with vestiges of my undergraduate empathetic self intact, the conversation went something like this: “This guy seems all right, but I don't know-- there's some things that are a little off, he's got some flight of ideas and loosening of associations...” “Christ, the guy's not suicidal or seeing monkeys or anything, send him out!” Thus was born the eponymous “Sensori-neural Simian Criterion for Patient Reliability,” which I've used ever since-- anyone seeing monkeys should probably not be discharged.
So, in honor of Dr. Gary Lombardi, I'll post a few of the thoughts I've had when thinking about the best of my profession. I'm sure Gary would make fun of me for it...
First and foremost, EPs have to be physicians. But their most important contribution or skill, unlike surgeons (surgery) or ophthalmologists (eye exam/Rx) for example, is communication. EPs are resuscitation specialists, certainly, but surgical resusc is also in the purview of surgeons, medical resusc in the realm of internists or intensivists. So, while the spectrum of the initial management of critically ill patients is certainly our emphasis, it is our personal skill at communicating during and about the care of the critically ill, or potentially ill, or not-so-ill-but-think-they-are that sets us apart as “good” doctors or not. As team leaders during a resusc, patient flow managers in a crowded department, providers of potentially critical patient assessments to consultants over the phone, re-assurers to patients being d/c'd, it is our ability to manage information and risk, in situations in which both can be incomplete or unknown that others count on. We are the improvisational obstetricians and the midnight therapists. We are the weekend dermatologists and the after-hours sonographers. We know which pills and why and will make sure you get them. We will get the iv, the pain medication, the tube, the turkey sandwich. We are emergency physicians, and you will do our best to get you our best.
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As an addendum, the following anecdote was emailed to a list of graduates of my program by one of the same. It's spot on. --aws
Gary Lombardi was an imposing individual, a bit hot-headed at times, and fiercely protective of his staff. One night, about 2:00AM or 3:00AM in the middle of a very busy shift, a gentleman was acting in a somewhat menacing and combative manner toward the staff. When Dr. Lombardi heard about it the veins on his temples throbbed and he started pacing about urgently. Finally he went over to the cube, threw the curtain open, glared at the gentleman lying there, and shouted, "Do you have a problem? Maybe you want to share that problem with me! What do you say? You want to share that problem with me?" The patient was stunned into silence.
Several minutes later one of the nursing staff tugged at his shirt. "That was the wrong one. It's the guy next to him, the one to the right of him." More pacing. Veins nearly popping now. He went over to the neighboring cube, threw its curtain open, glared at this new gentleman, and shouted, "Do you have a problem? Maybe you want to share that problem with me! What do you say? You want to share that problem with me?" He too was stunned into silence.
Then he leaned back a bit, glanced into the first cube, opened up the curtain about half way, stared at the first gentleman, the one whom he had mistakenly addressed that first time, and said, "And I'm keeping an eye on you too, buddy."
Oh, how I miss the Bronx! And Gary Lombardi. How I miss him!
