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Tuesday, June 23, 2015

Advice for Young Doctors, Gleaned from Goodbyes

This morning's farewell was a breakfast party (complete with chocolate cake, above, as all breakfasts should be) with our Paeds team, including nursing staff from the BKKH floor, the Family Clinic, the nursery, the ICU . . the many places around the hospital where Paeds patients are seen.  I am grateful for the steady pace of closure, the ebenezer-opportunities to reflect on God's grace, to be thankful for friends, to say goodbyes in the truest sense of "God Be With Ye".

As I reflect on what people say at these events, I realize that the things I tend to think make a great doctor, and the things which truly do, are two different lists.  Not one person in now four parties has mentioned a dramatic story or clever diagnosis.  A certain level of competence is essential, but brilliance is overrated.  I remember the baby who was dead post-exchange transfusion, and nothing brought him to life until I pushed calcium, and he literally resurrected, and a year later I saw him in clinic a normal toddler.  Or the infant born with such severe swelling (hydrops) she looked inhuman, and after a long ICU stay being told "this is the last chest tube we have", and praying, and against extreme odds she survived and mom sent me pictures on her first birthday.  That kind of wonder.  But those are like peaks of mountains, rarely seen, and not commonly traversed; occasionally beautiful, but not where most of us live.

So here are the basic essentials that nurses and trainees and administrators and colleagues notice and remember:

1.  Come when you're called.  It's that simple.  Keep your pager by your bed, keep your phone ringer turned up, and answer.  When someone wants you to see a patient, show up.  Don't make excuses.  Don't complain.  Don't make people feel bad for calling you, even if it was silly.  Just show up.  It's probably the #1 thing I've heard in the last two weeks.  Your nursing colleagues want to know you have their back, you won't leave them to manage alone.

2.  Listen to the nurse.  You might be covering 50 kids on four services scattered all over, she (or he, but mostly she here) is watching 2 or 8 or 10 closely within arm's reach.  She notices when breathing changes, or feeds aren't actually going so well.  If you're thinking of making a change in management, ask her what she thinks, and take her opinion seriously.  She knows if the endotracheal tube is still necessary because lung secretions are too thick.  If she tells you the patient is worse, listen.

3.  Be clear and definitive in a crisis.  When the kid is coding, then everyone needs the confidence of a leader who assigns roles by name, who orders the sequence of treatment, who has a plan and communicates it.  Listen 95% of the time, but when someone is dying, be ready to take action and responsibility.

4.  Stay organized.  Keep up with the details.  Your team wants to know that you're paying attention.

5.  Let your heart shine through.  People are watching, and they take encouragement when you sit and counsel a family, when you pray, when you go an extra step and care.  You can't fix every problem, you can't even fix most of them.  But you can show compassion for every patient.  Be willing to raise funds for those who can't pay.  Be willing to weep sometimes over a poignant sorrow. Invest in relationships around you.

Medical school is fascinating, but most of the above I learned from my parents long before.  Come, and listen.  Take charge in chaos.  Pay attention.  Be kind.

These are the characteristics of a doctor that nurses want to work with, and that is who you want to be.

If any students or trainees are reading this, let me end with the testimony I shared this morning.  There's nothing like goodbyes to make you realize the treasure you've been given.  This was the prayer guide for my mom's prayer group this week:

Give them a strong sense of purpose so that they are led to the right occupation and are always in the job or position that is Your will for their life.  Speak to them about what they were created to do, so that they never wander from job to job without a purpose.  Help them find great purpose in every job they do.

And as I prayed it, I realized how it had been answered for me.  This job, being a missionary doctor, is what I was created to do.  It's impossibly straining and wonderfully fun, both at the same time.  Hang in there, because this is the best job in the world, and so worth it.


Edgar Gulavi said...

Thank you Dr Jennifer for those wise words and for sharing your knowledge with us. But the thing I will mostly remember you by is not even the medical teaching they you gave me (and they were many) but that you taught me that every patient matters, all life is worth fighting for. Whether it's 4:45pm just before leaving the hospital or its 3am during a busy night call.... Show up and do your best for the patients . God bless you in your new assignment.

Anonymous said...

I'm two weeks away from starting my first job as a doctor, and I've been reading your blog for a few years now as a medical student - thank you for the wisdom in this post, and the hundreds of posts before it! Every blessing as you guys move onto the next adventures!

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Molly Shankles said...

On the eve of Medical School beginning (literally tomorrow), it seems quite fitting that I would come back and catch up on this blog and find this post. So blessed by the words you offer. Keep listening, keep working, and keep loving. It is a sweet sweet gift.