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Viewpoint: How to be EPIC

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000524803.84088.13

Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is exceptionally skilled in the avoidance of meetings, as well as being very keen on teaching and getting her hands (very) dirty with clinical care. Any time left over is spent writing odd fiction. This leaves no time for domestic duties, at which she is an abject failure. This article originally appeared in the blog, Life in the Fast Lane,

Let it never be said that we resist change. We, the consultants in my ED, have been reinvented. Previously our title was duty officer, which had a pleasantly communist, scratchy, gray-overalled sound to it, but now we are the EPIC. An imperious title, in my opinion. It stands for emergency physician in charge. Here's where the duplicity begins.

I'm hardly in charge of my own brain, so feigning tight command of the beast that is the emergency department is a bit of a stretch. But still, I turn up for shifts. At least I dress appropriately. I wear scrubs, which make me look like a scrawny police officer but without the fun stuff hanging from my belt.

I carry the phone. Yes, the one that has the broken ice cream truck ring tone that peals out horribly during the depths of somber conversations; the phone that conveys endless information about patients who may or may not pass through our doors or otherwise random requests or facts upon which I am allegedly supposed to act. With this, though, I am firmly in charge. I don't answer it. That's the limit of my in-chargeness, I think.

The days vary, like all good days in the vortex of Mount Doom. Let's take one. I start the day by thinking about coffee. My thought is then rudely interrupted by waves of patient chaos. Busloads of them and their relentless pathology. By 9 a.m., I am wondering whether I am coming down with some rare form of illness, perhaps vasculitis or takotsubo cardiomyopathy, but it turns out I just want coffee.

I am supposed to be at, or possibly in, a huddle. I didn't know what a huddle was. I found out that it is a meeting of people who play a pivotal role in managing patient flow, people who will tell me exactly the number of beds we don't have. Some people will get told off. I don't get told off because I don't know such meetings are being held. And I don't answer my phone.

Next the bat phone goes off. This is good because this is what we train for. The registrars go head-to-head, fighting to answer the phone because whoever answers it gets to run the code. A registrar is injured in the elbowing melee. He needs to go lie down in resus. As I am puerile, I announce the incoming code over the tannoy like an air hostess. No one is amused.

The code is a patient with crashing sepsis. Because I am so EPIC, I am not allowed to touch the patient. I look longingly at the patient's veins, and imagine slipping a central line into the subclavian to a round of applause, using only landmarks and the fairy dust of a clinician who has been around for so long that she has a sixth sense of where these structures are, like a Baggins in the Shire. This does not happen. The registrar slides the CVC in with exquisite skill, brandishing the ultrasound probe like nunchucks. He does not need applause.

By now my need for coffee has become sentient, and is talking loudly in my head and causing hallucinations. I decide I will have to drink the hospital brew. Sadly, our hospital cafeteria has insisted that the coffees need to be reproducible, so they have replaced the baristas with an automated grinder. I am not joking here. Something about benchmarks and KPIs. For coffee. At this point, it doesn't matter. I am prepared to drink anything, and don't judge the drink for its dystopia.

I am ready then for the next patient (keeping in mind that I am so EPIC that I know exactly what's going on with every single one of the 45 patients in the emergency department—what their plans, vital signs, and back stories are, as well as the reasons for their breaching some weird, militarily-enforced time target. How? Well, that is the secret of being EPIC). The next patient is a rather bloody and moderately deconstructed trauma victim of speed and inattention. This time, I get to watch a registrar running the trauma, doing something called a workplace-based assessment. This seems to be a mechanism designed purely so someone as garrulous as me is forced to shut her mouth and watch a trainee perform. This way I can constructively educate and assess the registrar at the same time. My hands are so itchy to get in there and be involved in the intimacy of patient care that they could be weeping in my pockets. The registrar does a fabulous job, and I have only interrupted her about 18 times. The patient does fine.

I've had enough. I want to see a patient myself. I sneak into a cubicle and stealthily close the curtain, where I begin to take the history of a fabulous old man who has been waiting (patiently) for three hours to be seen. He is telling me where he fought in the war. But now I am hauled away to a meeting because I wasn't smart enough not to answer the phone. I am in trouble. They ask me why it's taking so long to see the little man who fought in the war. I would like to make a witty joke about the irony of this, but the people with clipboards don't look in the mood for a joke.

Basically, the day continues like this. Sometime after lunch I feel I would very much like a nap. I look plaintively at the distressed relative's room, and wonder if I could jigger the lock so I could have 40 winks, but the phone rings again.

I am surprised by the variety of requests that come through on the EPIC phone. Mostly my job is to try to concoct an answer without getting too cross. Often the answer will end up being of little use to anyone, but I have learned to phrase things just right so nobody knows that until well after they've rung off. A resident calls in sick. This is bad because it now leaves the number of residents to staff the evening shift as a negative integer. We are suffering from junior staff cachexia at the moment.

Everything has been downgraded. For political reasons, our hospital has been repurposed and rebranded. We used to be the state's top dog, but now we are the punchy little sibling. Things may well change, and it is likely they will. Working here for decades has made it clear that the health ride consists of the dizzying peaks of the roller coaster interspersed with gut-dropping lows, complete with arms flailing and eyes squeezed shut (or that could just be me). I am immensely proud to work among a team that has hung in there, undistracted for the most part by the flighty decisions made by health bureaucrats. The professionalism and commitment of my brethren to patient care has never wavered.

And then, just like that, the day ends. My shift trying to keep the lid on the bubbling pot of entropy is done. I hand over the phone. Someone else gets the chance to be EPIC. And I'm sure they will be.

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