Who is Your Favorite ED Mentor?…Maybe its your Two Year-Old

Author: Joshua Schiller, MD (Assistant Residency Program Director, Maimonides Medical Center)

A little more than ten years ago I was the oldest medical student in my class, about to graduate and living in the fast lane that only NYC can provide.  I had been beating the work hard/play hard drum for so long—and so well, I might add—in those days that I couldn’t think of anyone more ready to be an ER doctor.


I still remember a moment I had heading home after a long night out after work.  It was dawn in early spring.  I caught my face in the reflection of a quiet storefront I was passing.  It was unexpected—at first I thought it was someone else—haggard, mildly self-satisfied, otherwise utterly blank.  My true neutral face.  This was the reflection of what my lifestyle was, and how I viewed work as a seamless cog in the overheated machine of living.


I had a similar moment of reflection last night.  It was a similarly quiet dawn in NYC.  However this time I was staring into the bedroom mirror immediately after my two month old had vomited onto my lap as I cradled her on my bed.  My eyes intuitively met their reflection in a panic, and there it was—haggard, self-satisfaction…but there was something more.  It was no longer blank.  Instead it was entirely present in this moment.  This new attention span was new for me.  A good thing, ok a necessary thing for the sake of parenting.  But what I’ve come to realize is that this little vomiting human, along with my perpetually trouble-making two year old have made me a better doctor.


Actually, it’s a symbiotic relationship, doctoring and parenting derive from a similar set of subtle principals of care.  It is the work of one who is giving.  It begins with the realization when I first became a parent that children are teachers.  They instruct us on our attention to their needs, and of course it is not subtle when our attention is not meeting up to standards.  Patients are similar, they remind us of what its like to be vulnerable.  They make us confront our ability to care, something we often forget as time goes on treating the constant stream of ER patients.


In this regard, children also remind us of the values that brought us to medicine in the first place.  My response when reading the personal statements of medical students applying to EM often induces me to think: ahh, the naiveté!  We all know that much of the messaging of hope and genuine desire to help those is in perpetual risk of being hammered out of residents during their training.  My kids reacquaint me with the sensitivities required to listen and soothe those who are in discomfort.  I simply cannot lose my marbles when my infant vomits all over my lap—not always successfully mind you.  Nonetheless, the practice of keeping calm with simple repetition covering everything from cleaning diapers to fat lips enables me to translate that to the bedside without feeling like I’m faking it.


Others I’ve worked with have noticed how I’ve changed in the ER.  Moving from my usual irascible character when I first started as an attending, I am calmer in stressful moments and less reactive to the inevitable provocations of difficult patients.  Last week, while attempting to calm a psychiatric patient, the agitated man reared back and launched a large globule of mucus, full-on, all over my chest and neck.  I was actually surprised by my lack of reaction, but I had experienced far larger quantities of bodily fluid sprayed on me over the past weeks in the comfort of my own home.


Patients also need explanations.  As doctors, we are traditionally lacking at speaking in a manner that is understandable.  In this way, we can “parent” our patients by taking the time to explain any number of things that may be potentially scary or intimidating in the ED—procedures that need to be performed, side effects of medications, results of tests, etc.  To allow for this, we delineate time and attention to create a connection necessary for learning and a sense of calm in an otherwise chaotic work environment.  From this process stems empathy and compassion that is not lost on our customers.


We are very lucky to do what we do, and should feel humbled by the trust society places on us to treat them at their worst.  In the realm of academics, we deservedly attribute our knowledge to experienced masters, well-grounded literature, and of course our patients.  However, there may be a source of insight sitting right there in the high chair next to you, smearing food on the wall, and who is looking at you for answers, hope, and comfort.

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