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.
Thank you.
* Names have been changed, though I very much
remember—and acknowledge—the actual people involved.
