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Emergentology: Your Emergency Family

Walker, Graham MD

Emergency Medicine News: May 2013 - Volume 35 - Issue 5 - p 12
doi: 10.1097/01.EEM.0000430477.77657.0f

Dr. Walker is an emergency physician at Kaiser San Francisco. He is the developer and co-creator of MDCalc, a medical calculator for clinical scores, equations, and risk stratifications, and The NNT, a number-needed-to-treat tool to communicate benefit and harm. Follow him on Twitter (@grahamwalker) for daily thoughts on emergency medicine.





One of my favorite lines is, “Emergency medicine is a team sport.” More than any other field, we take pride in using everyone's skills to help care for a patient and keep the department alive. More than any other field, we realize — and appreciate — that if any part of the team starts to sink, everyone pitches in to bail water to keep the ship sailing.

And we share the same experiences. We all get frustrated with the alcoholic who won't stay in bed and keeps yelling at everyone, no matter if it is a doctor, nurse, tech, or housekeeper. We all smile at the cute little old lady dressed prim and proper from head to toe who syncopated during church. This camaraderie is something of which I'm immensely proud, and it is one of my favorite parts of my work: being part of a medical team, being part of something that is greater than the sum of its parts.

Maybe team is the best analogy. (I wouldn't know; sports were not my strong suit. My high school letter jacket would have been for playing in the orchestra.) But I have to at least posit that a better term for the group of people staffing an emergency department might be family.

It's the same type of family feel that I have with my core group of friends from college: people who know you inside and out, who can predict your next move or your reaction to a particular situation. People who have seen you grow and change, people who have seen you at your best and worst. They have celebrated the highs with you and helped you through the lows. (And they have pulled all-nighters with you, too.)

Even more like one's own family, your emergency department family will always add some members when others have outgrown the nest and need to move on. And sadly, some of our ED family will die.

I've lost two wonderful, incredible ED family members in the past two years, both suddenly without any warning, and their deaths and absence had such profound effects on us all that it makes the word team seem just too informal.

We see such a strange, incomprehensible dichotomy in the emergency department; we are constantly being reminded of the fragility of life and its resilience. We see lives taken in an instant — a gunshot wound to the head, a vfib arrest, or a freak accident — but we also see the miraculous recovery of a patient we saved or the seemingly infinite chances the universe gives to some of our frequent fliers who somehow recover over and over from seizures, subdurals, severe sepsis.

It's hardest, I think, when we lose one of our own. We care about all of our patients, but not in the same way that we care about a loved one, a family member, or a friend. One of our nurses put it best, talking about the sudden death of one of her best, brightest, and hardest working colleagues, Randy Nadeau. “It just doesn't seem right that we can help other people, day in and day out, yet we didn't even get a chance to try to save him.”

Randy was an amazing person. He was one of those nurses who was just so calm and caring that you wondered what his secret was and you hoped he would share it with you. The department could be just starting to calm down from a four-hour frenzy, and Randy could still triage a “I ran out of my Percocet prescription” patient without even a hint of frustration or annoyance in his voice. It just didn't get under his skin. He was constantly be running around, helping out other nurses with blood work, charting, discharging patients, or asking the doctor for the plan, reminding you that, yes, all your labs and x-rays were back.



Somehow he was just as nimble and knowledgeable outside of work. I told him I was thinking of buying a house at some point in the next year, and he started giving me tips, showing me websites, and giving me the lowdown on loans and real estate in the insane San Francisco housing market. Two hours later, he was pulling up houses online, saying why I'd like this one and why that one was overpriced. He seemed to have mastered nursing and everything else in the universe, and he made it all look easy. We are all devastated and a little less whole knowing that he was gone.

Matt Curley, or Curley as he was so affectionately known, shared Randy's ability to smile and rise above the stress and chaos that is so routine in an emergency department. My residency family lost him in his last year of residency, about a year and a half ago now, and he is just as sorely missed. Matt had an infectious, wonderful laugh and a really great (and hilariously childish) sense of humor.

I was always jealous of his adventurous nature and fascination with the outdoors. I'd briefly catch up with him after a few weeks of not seeing him, and he'd have just returned from Argentina, deciding he wanted to see Patagonia, and so he'd just … gone. He spoke 10 words of medical — not conversational — Spanish, and still made friends while he was there. He even ended up in the middle of Bangkok during its Red Shirt revolution and managed to have fun and make even more friends. In the middle of a civil uprising.

Keeping the folks back home in mind, he brought home revolutionary head bands for friends and family. Carefree and a great emergency physician. His death was devastating to us all, especially because it felt like he never even experienced the really enjoyable part of residency: graduation.

Every person in our emergency department family adds a little something to its culture, something that can never be replaced when they're gone. So take a minute to tell your ED family that you appreciate them during your next shift, that you love them. Let them know how important they are. If you don't do it now, you may never get the chance.

This column is dedicated to the memories of Randy Nadeau and Matt Curley, along with all our other emergency department family members who have moved on to the Great Beyond. We miss you dearly, and you will never be forgotten.

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