Friday, September 16, 2011

The Reminder--EKG #6

Once a week, our residents in our Emergency Medicine program spend a complete morning attending hour-long lectures by various attending physicians from various medical fields, lectures that pertain to our specialty and contribute to their font of knowledge.

As with any lecture series, some can be fantastically entertaining while others can  be painfully boring, a timeline made of silly putty stretched much too long. I had no idea that the dry, cynical cardiologist I experience during a typical shift in our ER is the same guy who can deliver a funny, informative, engaging hour of information on cardiac resuscitation. Likewise, there is no amount of abnormal x-rays and CT scans that can save the dry delivery of the well-intentioned orthopedist talking about rare injuries. Sometimes, though, it is the subject material that can make or break the hour. Quite honestly, if I never hear another lecture on abscesses, I will be alright. I promise.  

Once a month, my duties include proctoring these morning lectures. Sitting through them, I have learned much. I have seen successful deliveries and I have seen miserable presentations. I have laughed to the point of almost being incontinent, and I have been bored to the point where watching a fallen eyelash on my desk sway from the air conditioner was much more entertaining. One of my favorite things to see in a lecture, though, is when the lecturer tries to engage our residents in a discussion on the hour's topic. Some of the residents are remarkably bold and astute during these types of lectures, participating without fear of being wrong with their answers, while other residents simply stare at their shoes or decide that the flaking cuticle on their left index finger suddenly needs their attention. Avoiding eye contact avoids engagement.

In the past year, though, several of our ambitious residents have asked for a slot of lecture time to review EKGs, to go over interesting cases from our ER, or to review subtle abnormalities in lab work or x-rays. They are willing to put in the extra time to become better doctors. The presenting residents manage the hour how they like and, quite honestly, I am very impressed with their presentations. And those comrades who normally stare at their feet? Even they participate in the spirited conversations that lead from these presentations. It is nice to see their confidence grow in a nurturing setting, a far cry from being lambasted by an asshole surgeon during their surgery rotation.

So, it was with this frame of mind a few months prior that I sat proctoring one of these resident presentations. It was on abnormal EKGs and, as I expected, it was going very well, the residents very interested in interpreting some very bizarre tracings. After a heated discussion on EKG #5, the resident continued with his presentation, clicking the computer button to advance EKG #6 to the big screen. Little did I know that this next EKG would transport me back to wistful memories.

Most of the EKG tops are whited-out, protecting the patient's confidentiality. The official interpretation of the EKG is also whited-out, to make our residents honestly review and interpret the EKG on their own. What isn't whited out, though, is the name of the EKG tech who performed the EKG on the patient. And there, in the left lower border of the EKG's information box, sat the technician's name.


Oh, Gigi. How you are missed! As talk continued in the room, voices dimmed as my mind raced back
several years, to thoughts of a spectacular human being who reminded me of the power of human kindness and compassion. Of the lost art of wanting to learn about your fellow human being. Of just being a good person wearing a big smile as much as one can. She was a hero of mine, and I wrote a piece about her that still makes me choke on my tears (Heroes Among Us--Gigi). Personally, she was a person who cared about me, who cared about my family, and mostly, who cared about my son's battle for his life. She was real. A co-worker like her I will never have again.

The residents finished interpreting the EKG and before clicking to EKG #7, I held up my hand to speak. I hesitated before speaking, all the residents' eyes on me.

"There is something more important about this EKG than it's tracing,"  I began. "Look at the  name of the technician on the left lower border." All of the residents' eyes glanced at the name and then turned back to me. "Do any of you remember this technician?" I asked, knowing that Gigi left right before our most senior residents arrived. They all shook their heads "no" to my question.

"Well, then," I continued, "let me tell you about this magnificent lady." And with that, I proceeded to share Gigi's story with them (I knew she would have let me). I told them how she treated patient's in their room, spending the five minutes it takes to get an EKG learning about the patient, their family, and their illness. Sometimes I heard laughter, sometimes I saw the beginnings of tears, but always I witnessed the boundless kindness and caring compassion that Gigi gifted to every patient she encountered. Then I told them about her concern and hugs through my son's illness and beyond. She saw through my anxiety, my hurt, my pain, and my fake smile as I struggled to maintain my professional life while my personal life was in shambles.

She is one of my heroes and when she passed too soon from this life, I knew the angels were singing in heaven.

The residents continued to watch me as I finished talking. "Just remember," I said, "that it is a privilege to help a patient and their family through a time of need. You can make this 'a job'," I continued, "going through the motions of what is expected of you, or you can embrace the privilege you've been given and do your job with pride and compassion."

The room was quiet. I was still being watched. "That's all I have to say about that EKG, then." Most of the residents slowly turned back around to face the big screen, to review the next EKG, but a few lingered. I think they heard what I had to say, but one can never be sure.

I'm not naive. I know there are people who probably laugh at the thought that one can always be compassionate and kind, especially in a busy ER such as ours. And they would be right. It is impossible to extend oneself to every encountered patient. Heck, even I get cynical and sarcastic, some days worse than others. I am human, after all. But my hope, by continually harping it, is that some of our residents remember why they went to medical school. Not for money. Not to play the number games that we now must play (insurance company numbers, patient survey numbers, patients seen per hour numbers). Not to expose oneself to lawsuits. But rather, to make a difference, a real difference, in some of their patients' lives.

Thanks, Gigi, for the reminder.

Big thanks for light of this past weekend of the tenth anniversary of 9/11, I wanted a story to remind us that we are all in this world together. Try as we might, we can not unweave the fabric of humanity. To the victims and their families of 9/11, you are not forgotten...your personal pain is our the heroes, we are eternally grateful for your bravery. Thank you...