The Lessons Never Taught
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.
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.
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.
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
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.
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.
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.
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.