I love shadowing in the Emergency Department (ED). I get to see patients from every corner of my curriculum – dermatology, oncology, cardiology, nephrology – you name it, it’s there. There is a palpable buzz and attitude that is exciting and raw, and you get to watch how the residents flow through their list of patients, treating and triaging as they discuss their clinical assessments. I feel fortunate that while I watch the doctors from behind less experienced and weathered eyes, I can still see the patients and the atmosphere of the emergency room with a sense of idealism. Additionally, as the doctors must deliberately budget their time with patients, I have the luxury of being able to learn without time constraints.
Under these circumstances, my complete lack of concrete responsibilities allows me to experience the ED in ways that many doctors can no longer experience it themselves. The doctors are usually more than happy to pass along their knowledge, experiences and stories, but they can also sometimes be dismissive, disengaged, or a bit rough around the edges. As a medical student that can be discouraging, especially when you’re entering with an idealistic enthusiasm to heal. Fortunately, all you need are a few positive experiences and well-trained mentors to keep your passions alive. You may have some mentors for years, and you may have others for minutes, but the good ones you never forget. Dr. Probst was one of the good ones. He was what I call a one-minute mentor, but his advice helped sculpt the way I approached shadowing during my first year. In fact, in a minute of mentoring he taught me something that I may use and pass along for the rest of my professional career.
It was 10pm on a weeknight, and I was shadowing the junior resident in the ED. It was busy, so I didn’t take it personally when they did not have a lot of time to involve me in the patient care. While I was watching them enter notes in the resident workroom, Dr. Probst, whom I had introduced myself to at the beginning of my shadowing shift, popped his head in and asked if I wanted to see a patient with him. As any interested student would do, I lit up with a smile and said “of course!” We went into the room of a 74 year old woman who had fallen on the sidewalk and hit her teeth. Her mouth was bleeding a bit, her teeth were somewhat disfigured, and she was trembling with fear on the gurney. She was confused, she wanted her family there, she didn’t know what had happened to her teeth, and she wasn’t sure what was going to happen next. I noted how calm Dr. Probst was with this woman. His bedside manner didn’t seem to come down to what he said, or even really how he said it, but to who he was as a person and physician. It didn’t feel like an act, it didn’t feel like he was trying to calm her down, his empathy was genuine and his passion for helping this woman formed a trust and connection with her that wiped away any anxiety she was carrying.
I was standing a respectful distance back while Dr. Probst and one of the residents discussed how they were going to use some dental paste to temporarily fix her teeth until she could go to a specialist. Once they decided on their plan, I asked “is there anything that I can do to help?” There was a pause, and then he said “I’m glad you asked, come over here,” as he waved me towards the bedside. He took the patient’s hand in his own, and passed it over to me. He looked directly at me, gave a gentle smile and told me to emotionally support our patient and keep her calm through the procedure. Despite not being completely sure what that may entail, the confidence he showed in my ability to calm her brought out the best in me. When he passed me her hand it felt like he had passed me some of his confidence as well, because four minutes later the woman had finished the procedure without a tremble and without a tear, while expressing gratitude and respect for everyone in the room, myself included. Dr. Probst looked over to me as he took her other hand and said “This, this is one of the most important things we can do here.” And with that, my minute-mentor was gone, and I was left to ponder what had just happened.
When I had a chance to really think about my experience with Dr. Probst, this is what I learned. The often overused term, “bedside manner,” is no joke. It can be as powerful as the placebo effect, and just like the placebo effect, it cannot be elicited without being fully committed to its efficacy. You cannot be self-conscious or clinical when you’re comforting a patient, you have to be committed. For me, this was an experience that straddled the line between the cliché and the compulsory, and it didn’t take me long to put it into action. The very next week, while observing a Nurse Practitioner I was shadowing drain the abscess of a scared 17 year old girl, I took a knee by the bedside without a second thought, held her hand, and experienced that procedure with her. She was clearly comforted as she held onto me. I wasn’t “trying” this technique out, I was doing it. Over the past year I’ve now held many hands, looked many patients straight in the eye, heard many stories, told some of my own, been in the way of nurses who needed that arm, and been thanked by parents and patients alike. It reminded me how useful someone without a “use” can actually be in the emergency department. It also showed me that holding a patient’s hand is one way I can hold onto the passion and drive that is medicine, even when no medicine is being administered.