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First Year PA

The Lessons Never Taught

Published September 19, 2013 3:09 PM by Harrison Reed
I remember all of my great preceptors: The ones who reaffirmed my choice of career or mentored my special projects or were less of a taskmaster and more of a friend. As a student, I pictured myself in their position, guiding some wide-eyed student through the treacherous surf of clinical rotations. I imagined that sage, professorial Harrison would have years of experience and a few gray hairs to prove it.

I was wrong. That first PA student bounced into my office during my first year of practice. She arrived to glean some wisdom from a veteran intensivist and instead found a fresh clinician still kicking the tangled graduation robe from around his feet. I've heard some cliché about faking things and making things and luckily, in this ICU, even just six months provides plenty of stories.

Besides, this PA student was sharp. She sat on the unit and dove into chart reviews. She tore apart the history and performed her exams on our sickest patients. She tackled ABGs and dissected the most complicated acid-base disorders. She was overwhelmed, she said, but then again, who wasn't? Perhaps the biggest difference between her and I was a diploma and a paycheck.

She was also lucky. Her first day with me in the ICU produced a shocking finish. A previously stable patient began to crash. As his heart rate soared and his blood pressure dropped and we slapped the pads on his chest to cardiovert him, my student witnessed a real critical care emergency. She stayed late to watch his intubation and by the time she left she had finally seen a truly sick patient.

But my student missed something. It is something I also missed as a student but it has defined my career in critical care. While the ventilator puffed its breaths and the vasopressors dripped and the million-dollar work-up cooked in the lab, we performed a different kind of task.

There was the long bedside talk with my patient's wife, the tears and the hugs and the promises to not give up. As my patient slipped into death that night, there was a phone call that left the base of my skull tight.

The next morning, another phone call, this one to my patient's daughter. It left a lump in my throat after all of the apologies and condolences had escaped. That afternoon, more phone calls: An angry brother who wanted answers-a conversation that left my head pounding-and a depleted widow who extended her thanks and broke my heart.

I wondered later if my student had missed out on the most important part of critical care. I wondered if I should have told her that the medicine was easy but the humanity was backbreaking. I wondered if it would turn her away.

Ultimately, I think she saw what she needed: the excitement and the glamour. After all, it's what draws us to critical care. That other part, the part when we tear off a little corner of our soul and hand it to each family, is reserved for us. Those brave or stupid enough to enter the ICU day after day may be driven away by the burden. Or they will stay because it is the only weight that feels real.


outstanding article, harrison.. strong words

Vanessa Colquhoun September 26, 2013 6:06 PM

I enjoyed reading how you were able to portray both sides of the student/preceptor dyad with such feeling.  

Another great article that was inspiring and heart-rending all at once, Harrison.  

Marjorie Shanks September 24, 2013 9:05 AM

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