- Email: [email protected]
Gut Feelings
CHANGE OF SHIFT
Gut Feelings Keith A. Raymond, MD* *Corresponding Author. E-mail: [email protected]. 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2016.04.037
[Ann Emerg Med. 2016;68:632-633.] While I was sitting in the nursing station on the medical ward writing notes one morning, a Jesuit priest came up to me. He was also an instructor at the medical school where I was just about to graduate in Philadelphia. He straightened up and thrust out his chest and said, “The practice of medicine requires self-sacrifice.” I stopped what I was doing, looked up, and frowned at him. Then he shifted into a Texas hold ’em drawl and continued, “If you’re not all in, then you are holding your cards too close to your chest.” This earned him a chuckle from me and a smile from some of the nurses who overheard it. I think about what he said every now and then. At the time, there were no helicopter HMOs, third party payers, and CMS withholding remuneration. Years into practice, I see the lawyers and businesswomen in the emergency department, and they scoff at such “sacrifice.” Even the administrators who come to the potluck empty-handed want to take home the leftovers. Yet there is one thing they can’t skim: it’s the reward of seeing a child smile for the first time after a long illness, a mother’s tear, a father’s joy. This is why we as physicians are all in. Perhaps the amount of sacrifice is measured in the degree of dedication. Still, every day, I learn from my patients, the ancillary staff, and colleagues. A paramedic who worked by my side in Buchanan, Liberia, taught me viscerally the nature of malaria, loa loa, and trypanosomiasis. He described it in brutal detail as they all afflicted him at the same time. After that, when I saw it in patients there, I understood it, appreciated it, suffered for it. As a result, when I worked in Dubai and a man came into the hospital after his third A&E visit that day, I knew he had malaria. I could almost hear the rupture of erythrocytes in his blood as his fever spiked. He was grateful somebody understood. That same paramedic in Liberia had been an Army Ranger before. Perhaps the bodies he had left in his wake were his sacrifice, and now he was making amends. 632 Annals of Emergency Medicine
The best thing he did as a soldier was to follow tribesmen deep into the bush. His mission was to dig a well in their village. Being young and incredibly fit, he was impressed by a much shorter man in his fifties whom he couldn’t keep up with as they hiked for miles through the jungle. Arriving in the village, he and his team spent days digging and installing the well. They didn’t understand the sense of it, as a river ran nearby that provided plenty of water, but they were under orders. The day they left the village to trudge back to their forward operating base, the tribesmen were grateful for the clean fresh water that no longer required carrying from the river. A week later, he was sitting whittling at the edge of the jungle when the elder tribesmen came and summoned him back to the village in a panic. The paramedic spoke to his platoon leader and they sent another medic with him due to the “outbreak.” This time the trip was long and even more arduous as the elder pressed them onward quickly. When the squad arrived at the village, the chief explained the problem. What it came down to is that the tribe had come down with hard formed stools. Having never had fresh water, they had all suffered from chronic diarrheal illnesses that came from the river. Once the paramedic explained that they were now healthy, and that this was normal, the tribesmen were suspicious. Of course, the soldiers had to provide proof of their claim, which they did the next morning. These new gut feelings in the village were a lesson of hope, and a message of self-sacrifice. Now, sitting in a travel medicine conference in Linz, Austria, taking notes in between writing this, I hear about the endemics of vaccine-preventable illnesses over the globe, the Pakistani physicians who sacrificed their lives to vaccinate, and the stiff-upper-lip American parents refusing their offspring the protection. The lecture before that was on patterns of antimicrobial resistance, and I wonder, with the closing of abortion clinics, if we are heading back to 19th-century medicine. Volume 68, no. 5 : November 2016
Raymond
Change of Shift
It seems we have to convince the suspicious tribe once again. Perhaps self-sacrifice was the wrong approach. Instead of self-sacrifice, we should offer them our personal enrichment. By spreading the wealth rather than self-sacrifice, we as physicians can strengthen our position by making folks
feel richer, encouraging them to belong rather than dissemble. If we feel better about ourselves, maybe patients will as well. Author affiliations: Muckendorf, Austria.
Annals of Emergency Medicine App Now Available for Android Devices The Annals app is available for both Apple and now Android devices. Take your journal with you wherever you go, even when you don’t have Internet access. With the mobile app, you can: Access the latest issue or view the journal archive Search to quickly find what you want to read Navigate quickly and conveniently to the content you want Watch videos and interact with images, tables, and more Personalize your experience with My Reading List, Notes, save favorites for offline reading, share arcles via social media, and more Download the app today from the Apple App Store or Google play!
Information for claiming access is available here: http://www.annemergmed.com/content/mobileaccessinstructions
Volume 68, no. 5 : November 2016
Annals of Emergency Medicine 633
Gut Feelings Keith A. Raymond, MD* *Corresponding Author. E-mail: [email protected]. 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2016.04.037
[Ann Emerg Med. 2016;68:632-633.] While I was sitting in the nursing station on the medical ward writing notes one morning, a Jesuit priest came up to me. He was also an instructor at the medical school where I was just about to graduate in Philadelphia. He straightened up and thrust out his chest and said, “The practice of medicine requires self-sacrifice.” I stopped what I was doing, looked up, and frowned at him. Then he shifted into a Texas hold ’em drawl and continued, “If you’re not all in, then you are holding your cards too close to your chest.” This earned him a chuckle from me and a smile from some of the nurses who overheard it. I think about what he said every now and then. At the time, there were no helicopter HMOs, third party payers, and CMS withholding remuneration. Years into practice, I see the lawyers and businesswomen in the emergency department, and they scoff at such “sacrifice.” Even the administrators who come to the potluck empty-handed want to take home the leftovers. Yet there is one thing they can’t skim: it’s the reward of seeing a child smile for the first time after a long illness, a mother’s tear, a father’s joy. This is why we as physicians are all in. Perhaps the amount of sacrifice is measured in the degree of dedication. Still, every day, I learn from my patients, the ancillary staff, and colleagues. A paramedic who worked by my side in Buchanan, Liberia, taught me viscerally the nature of malaria, loa loa, and trypanosomiasis. He described it in brutal detail as they all afflicted him at the same time. After that, when I saw it in patients there, I understood it, appreciated it, suffered for it. As a result, when I worked in Dubai and a man came into the hospital after his third A&E visit that day, I knew he had malaria. I could almost hear the rupture of erythrocytes in his blood as his fever spiked. He was grateful somebody understood. That same paramedic in Liberia had been an Army Ranger before. Perhaps the bodies he had left in his wake were his sacrifice, and now he was making amends. 632 Annals of Emergency Medicine
The best thing he did as a soldier was to follow tribesmen deep into the bush. His mission was to dig a well in their village. Being young and incredibly fit, he was impressed by a much shorter man in his fifties whom he couldn’t keep up with as they hiked for miles through the jungle. Arriving in the village, he and his team spent days digging and installing the well. They didn’t understand the sense of it, as a river ran nearby that provided plenty of water, but they were under orders. The day they left the village to trudge back to their forward operating base, the tribesmen were grateful for the clean fresh water that no longer required carrying from the river. A week later, he was sitting whittling at the edge of the jungle when the elder tribesmen came and summoned him back to the village in a panic. The paramedic spoke to his platoon leader and they sent another medic with him due to the “outbreak.” This time the trip was long and even more arduous as the elder pressed them onward quickly. When the squad arrived at the village, the chief explained the problem. What it came down to is that the tribe had come down with hard formed stools. Having never had fresh water, they had all suffered from chronic diarrheal illnesses that came from the river. Once the paramedic explained that they were now healthy, and that this was normal, the tribesmen were suspicious. Of course, the soldiers had to provide proof of their claim, which they did the next morning. These new gut feelings in the village were a lesson of hope, and a message of self-sacrifice. Now, sitting in a travel medicine conference in Linz, Austria, taking notes in between writing this, I hear about the endemics of vaccine-preventable illnesses over the globe, the Pakistani physicians who sacrificed their lives to vaccinate, and the stiff-upper-lip American parents refusing their offspring the protection. The lecture before that was on patterns of antimicrobial resistance, and I wonder, with the closing of abortion clinics, if we are heading back to 19th-century medicine. Volume 68, no. 5 : November 2016
Raymond
Change of Shift
It seems we have to convince the suspicious tribe once again. Perhaps self-sacrifice was the wrong approach. Instead of self-sacrifice, we should offer them our personal enrichment. By spreading the wealth rather than self-sacrifice, we as physicians can strengthen our position by making folks
feel richer, encouraging them to belong rather than dissemble. If we feel better about ourselves, maybe patients will as well. Author affiliations: Muckendorf, Austria.
Annals of Emergency Medicine App Now Available for Android Devices The Annals app is available for both Apple and now Android devices. Take your journal with you wherever you go, even when you don’t have Internet access. With the mobile app, you can: Access the latest issue or view the journal archive Search to quickly find what you want to read Navigate quickly and conveniently to the content you want Watch videos and interact with images, tables, and more Personalize your experience with My Reading List, Notes, save favorites for offline reading, share arcles via social media, and more Download the app today from the Apple App Store or Google play!
Information for claiming access is available here: http://www.annemergmed.com/content/mobileaccessinstructions
Volume 68, no. 5 : November 2016
Annals of Emergency Medicine 633