One Year After: A Tribute to Our Patients and Our City

Courtesy of NPR from npr.org

On April 15^th, 2013, I woke up at 5:30am and walked to Mass General Hospital to begin my ER shift. It was the day of Boston marathon, and we were prepared for the usual influx of people with heatstroke and dehydration. That day, as other days, we also treated dozens of critically ill patients with heart attacks, strokes, and severe infections.

Just before 3pm, we received the call that nobody could have predicted. Bombs had detonated at the Boston marathon. Many people were gravely injured.

Minutes later, they arrived in our ER. Some were not breathing. Others were missing limbs. All were covered with blood and soot.

As an emergency physician, I am trained to treat traumatic injuries. But while I helped direct our trauma teams to triage then resuscitate these patients, I was terrified. My husband and I lived in Back Bay, next to the explosions. He had texted me not long before to say that he was headed to the finish line to watch the marathon. I didn’t know where he was; I feared that the next patient I took care of could be him.

I wrote about this fear and guilt in an NPR article, and subsequently about the need to care for the many healthcare providers who served on that day.

Now, one year later, I no longer live in Boston, but I will always remember April 15^th. I remember the bravery and resourcefulness of the first responder, bystanders, and volunteers. I remember the teamwork in our hospital among every service—not just those of us caring for the victims themselves, but also those oncologists and obstetricians who jumped in and provided excellent care for other patients in our ER. I remember the support from our city and indeed our broader community in the U.S. and around the world. 

Most of all, I remember the courage of the victims and their families. Their resilience serves as inspiration for all of us.

As I remember April 15^th, I am grateful to have had the opportunity to take care of these brave men, women, and children. I’m honored to be able to serve and proud to be a physician and emergency care provider.

Four Years Later: Reflections From the Last Day of Residency

On July 1^st, four years ago, I walked through Mass General and Brigham & Women’s Hospitals with an odd mixture of fear, relief, and excitement. Now, as I leave the hospital after my last shift of emergency medicine residency training, I am filled with a similar hodgepodge of emotions and reflections.

#1. “You were terrified of being a doctor!” I mentioned this article to the attending who oversaw my first shift as a newly-minted doctor. That day is forever etched in my mind; did he remember it? Much to my great embarrassment, he chuckled and said, of course. “I kept telling you not to worry if you don’t know something, but you were scared of everything!”

Though I knew that I was there to learn, it took me a while to get over my insecurities about not knowing so that I could focus on learning. And the learning was everywhere—on every single shift, I learned from great clinicians not just about diagnosis and treatment, but also important lessons on how to lead a team, how to teach, and, most importantly, how to help people who come to us in their time of need. I’ve been incredibly fortunate to have learned from many colleagues along the way, including the amazingly skillful and compassionate nurses at Brigham & Mass General. As my mentors say, it is called the practice of medicine for a reason, and we should embrace, rather than fear, the learning.

#2. “Mistakes will happen.” Every doctor has made a mistake some time in her life. Whether it’s a technical error (i.e. inserting a long IV into an artery rather than a vein), a systems error (i.e. ordering a medication for the wrong patient), or a communication error (i.e. angering a patient or colleague), all of us graduating residents will have made some kind of error. I myself made all three of these errors, and more.

With the volume of patients we will see throughout our careers, being the cause of medical error and interpersonal conflict is a terrifying and humbling thought. A wise physician said to me that just as residency is the time to learn how to practice medicine right, it’s also the time to learn skills like how to disclose mistakes to patients, and how to deal with conflict. “Don’t shy away from difficult situations,” he told me. “Put yourself in the middle of them to see what others do, and then develop your own style.”

#3. “That man has a name, and it’s not ‘the chest pain in room 8.’” As busy residents with long to-do lists, we often fall prey to the tendency to dehumanize our patients and brand them as chief complaints to quickly decide their disposition. On the surface, this might appear to save time, but dig a little deeper, and such algorithmic, depersonalized medicine results in unnecessary tests, misdiagnosis, and worse patient experience.

Furthermore, practicing cookbook medicine is not why we chose to become doctors. My work became much more meaningful when I made a commitment to connect with each patient, no matter how busy I am. I learned that the “old guy with dementia” was a world-renowned philosopher, that the “the onc patient with fever and neutropenia” had ten children with her preschool sweetheart. As physicians, we are privileged to hear so many stories from so many people. Cherish this gift we’re given to share in our patients’ rich lives. Our healthcare system isolates patients and disenfranchises families; we have the power to practice real patient- and family-centered medicine.

#4. “Residency is hard, and you have to take care of yourself.” My best friend from medical school, who had just completed his pediatric residency, warned me about this before I started intern year. How right he was. Work hours may have improved since our forefathers trained, but residents still work a lot and are exposed to high-stress situations with life-and-death consequences. Studies have shown that rates of depression and burnout increase sharply during training, yet the “hidden curriculum” of medical training still favors bravado over openness. Residents are taught to “suck it up” instead of talking about difficult situations and taking care of ourselves.

This is not the way it has to be! I learned this lesson the hard way during second year of residency, when my mother died. I suppressed my emotions rather than seek help, and saw how easy it is to feel isolated. Fight this impulse and stay connected. Find peers you can reflect with and openly speak about your experiences. Nourish the other people in your life and recognize their critical role in helping you through this process. For me, it was my wonderfully supportive husband and my friends who sustained me and kept me grounded. Make time for these people in your life. I cannot think of anyone who regrets the time spent with our loved ones and laments, “if only I spent that day reading one more research article!”

#5. “Emergency medicine is a phenomenal field.” The first grand rounds lecture I heard as an intern was by Dr. Larry Weiss, then President of AAEM. He spoke about how emergency medicine is an ideal specialty for advocacy: as the frontlines of medical care who interact with every aspect of the healthcare system, we are the most well-positioned physicians to advocate for our patients, our communities, and our society. We see the problems with public health—smoking, obesity, gun violence, etc. We see the problems with under-, over-, and misutilization of healthcare. And we have the ability and power to act on these problems every day.

In my fourth year of medical school, I selected emergency medicine as a specialty because I wanted the ability to treat any patient, anywhere. Being one of the emergency providers who took of care victims of the Boston bombings made me grateful for my training and for the skills I’ve learned along the way. We in emergency medicine have the incredible opportunity to utilize our training to do what we love while making a difference to improve care for our patients and to transform our healthcare system.

What else can I say about these last four years? It’s been a rollercoaster ride. Now that I’m about to embark on the next journey as an emergency medicine attending physician, health policy professor, and Director of Patient-Centered Care Research at the George Washington University in D.C., I am filled with exactly the same emotions of fear, relief, and excitement that I came to Boston with. I have learned so much from so many incredible people along the way, and will forever be indebted to the amazing attendings, residents, nurses, physician assistants, and other colleagues at Brigham & Mass General Hospitals.

Now, what will the next years bring? I’ll be on leave for the next month, but stay tuned for more dispatches and reflections, soon to be from the nation’s capitol.

From the Frontlines: Reflections of the Boston Marathon Bombings

-->
“I have a recurring nightmare where I am performing CPR on a patient who turns out to be my husband.

Last Monday, my nightmare nearly came true.

It was 2:50 p.m., and the Massachusetts General Hospital ER was filled to capacity.

In the section where I was working, my patients were critically ill, with strokes, heart attacks and overwhelming infections. Even the hallways were packed with patients receiving emergency treatments.

A call over the loudspeakers announced that there had been two explosions. Many people were injured. That's all we knew.”

This is how last Monday began. The rest of my story, and my husband’s, is in my NPR piece.

It’s been a very long week in Boston.

I will write more of my reflections in the days to come, about destruction and terror, but also about collaboration and courage. 

Thanks to everyone for your support and well wishes during this trying time for our city.