It was my first shift as an intern, and I was terrified. I was assigned to the “Fast Track” area of the Mass General ER—a section designated for those with straightforward issues: lacerations, sprained ankles, etc. Overnight, though, I would be the only doctor in that area. I’d been away from clinical medicine for nearly three years, and was terrified of what that Saturday night would bring.
My first patient proved my ignorance. Mrs. R was a pleasant woman in her sixties who had gotten her left hand caught in the car door and was feeling pain in her third and fourth knuckles. I’d ordered x-rays of her hand, which showed a small fracture, and I was trying to figure out how to make a splint.
“Doctor, you might want to take another look at her hand,” her nurse, Kelly*, said.
I ran to the room. Even from the doorway, I could see that Mrs. R’s third and fourth knuckles had swollen to twice their size. The ring finger was turning a dark red, almost purplish, color.
This was an emergency! I couldn’t believe that I’d forgotten to take the rings off before the x-ray, and now they were compromising blood supply to the fingers.
But what do I about it now? Mrs. R was in obvious pain, but she was also crying that these were precious rings, given to her by her late husband.
I grabbed an ice bucket and some water-soluble jelly. Kelly frowned. “How about doing a digital block first?”
Numbing the finger…. that sounded like a great idea. But alas, digital block, jelly, and ice did not do the trick. “Maybe it’s time we get the ring cutter,” I said
“How about trying the string technique first—have you used that?” Kelly suggested. No…. but she had, and we succeeded in getting the rings off, without needing to damage them, or our patient.
The rest of the night was a blur. I remember my hesitation at ordering any medication stronger than Tylenol, and even Tylenol itself (“for God’s sakes; mothers give it to their babies!”.) I remember my first car accident victim, M, an intoxicated young man who had been struck while walking across the street. He looked fine to me, but his nurse, Ann, didn't think so. He was sweating and looked confused, not drunk. “Let’s move him to another area,” Ann said. She was right—he turned out to have a bleed in his brain and a large femur fracture. Her clinical acumen saved our patient.
Thankfully, I have matured as a clinician since that terrifying first day, though the training process was not without its bumps and bruises. I and my fellow trainees frequently credit the attending physicians and senior residents from whom we have learned so much. This praise is deserved, but I also want to acknowledge another group of people who have instrumental in teaching and guiding us: the nurses.
Over the last four years, I have had the honor and privilege of working with and learning from the terrific nurses at Brigham & Women’s and Mass General Hospitals. Time and time again, these nurses have saved me from making mistakes, big and small. They have taught me clinical judgment and clinical skills. They have demonstrated true patient-centered care, and shown me what it means to really listen. They have inspired me to always be vigilant and always care.
In my second year of residency, my mother passed away from metastatic cancer. Before she died, she told me that she wanted to make sure I thank her nurses, because it was they who she thought really cared for her.
It was they, too, who cared for my family and for me. After we decided to withdraw her life support, I was wracked with guilt. It was what my mother had wanted, but kind of daughter was I to end my own mother’s life?
All the doctors had left. Her nurse, Andy, came to find me at my mother’s bedside. He told me about how he had to make a similar decision to allow his terminally ill wife to die. “It’s what she would have wanted,” Andy said. “You are carrying out her last wish, to die peacefully.” I will never forget his words and his kindness.
As I near the end of my training at last, I am reminded of the Hippocrates saying that the goal of medicine is “to cure sometimes, to relieve often, to comfort always.” This, too, I learn through daily example from the amazing nurses I work with.
* Names have been changed, though I very much remember—and acknowledge—the actual people involved.