President's Message, COVID-19, Career Planning

Looking Beyond the Uncertainty

The first thing I notice about a patient are their eyes.

Are they open or shut? Are they bloodshot? Are they avoiding eye contact? When we look in someone’s eyes, emergency physicians get an immediate sense of what we will encounter as our time together unfolds. Not only do we begin to gather pertinent information for our physical exam, but we also see the emotions underlying their chief complaints. As I reflect on my time as EMRA president and on my first year as a brand-new attending, I also wonder what people saw when they looked in my eyes.

Did my very first patient see any uncertainty? His chief complaint was dizziness, and his symptoms were vague. I looked in his eyes, searching for nystagmus or any other clues I could use. As I examined him, differentials swirled in my head, and I tried to decide if I should call a stroke alert. That uncertainty left me with a sinking feeling in my stomach, and imposter syndrome began to set in.

We all have that feeling at these times of transition. These transitions tend to happen in summer, as one academic year moves into the next. As we adapt to starting medical school or clerkships or residency, we know our training and preparation are designed to propel us to success, but we also appreciate the magnitude of what we cannot know. I leaned in to my uncertainty and decided to ask for help. I called a stroke alert and spoke to a neurologist. I looked her in the eyes as I described the patient’s presentation, and she agreed the presentation made diagnosis difficult. I breathed a sigh of relief, realizing I was not alone in my uncertainty. I was beginning to build what would become strong relationships with our consultants.

Later in the year, as the winter set in and the pandemic worsened, a nurse pulled me into a room. He looked concerned and explained that his patient arrived in respiratory distress, and she was not responding to the BiPAP EMS had provided. I called for respiratory therapy to join us, and I looked in my patient’s eyes. I saw fatigue, and I knew she needed immediate help. Between shallow breaths and coughing fits, she shared that her partner recently died from COVID-19, and she wondered if she would survive. I maintained eye contact and did my best to comfort her as we discussed intubation. The pandemic has shown all of us how little certainty we can have in these situations, and balancing the desire to be both honest and reassuring is never easy. As the sedative was pushed, her eyes became glassy, and then they slowly shut. I wondered if they would ever open again. After intubating her, I looked up at the staff around me; the patient was not the only one with fatigue in her eyes.

Navigating uncertainty through challenging times has been a hallmark of the past year, and it became even more apparent in the spring with the release of the report about the changing EM workforce (acep.org/workforce). I see the impact of this when I look in the eyes of EMRA members who have already felt the pressures of these changing workforce trends. We have the opportunity to look this challenge in the eyes and make a decision: We can sit back and wait to see how it unfolds, or we can lean in to our uncertainty and look for solutions. Now is the time to have difficult conversations, including conversations about our own residency training models and about the impact of business interests and other providers on our training and practice. EMRA's recent Workforce Town Hall showed that our members are ready to have these difficult conversations.

Whether I am with patients as their doctor, with consultants as their partner, or with you as EMRA's president, I see it as my job to look a person in the eyes and share what I know and what I am uncertain about. I am uncertain about the future, but I know it looks different. I know that we have more power when we band together to make change. I know we have the power to design our future, a future where our generation leads, with new solutions for safe and effective patient care.

As we embrace the uncertainty that summer and its associated transitions inevitably bring, keep in touch. I hope to be able to look you in the eye in person at a conference very soon. In the meantime, email me at president@emra.org to share your ideas for the future. Let's find ways to support each other and work together for a better future.

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