I listened to EMS’s story (hypotension, bradycardia, altered) via the new electronic medical record then looked to head of the bed for my PGY-2, who would already have a GlideScope, bougie, and endotracheal tube ready to go. Instead, there was a nurse at the head of the bed, waiting for me to say something. My eyes then scanned the entire room for familiar sights (interns, residents, onlookers); there were none.

After graduating from the residency program at St. Luke’s-Roosevelt Hospital in New York City, I continued working at the same hospital for several years. I was the assistant program director for two years when I made a huge life change last summer. I willfully stepped off of the academic train, but transitioning to a community hospital has not been the smooth ride that I expected.

Residents Versus No Residents

Getting back to my first shift without residents, in Catch Me If You Can, Leonardo DiCaprio briefly plays an attending. He fakes his way through medicine by asking for one resident’s opinion, then turning to a second resident and asking, “Do you concur?” In some ways, I spent years asking, “Do you concur?” without having to initiate a plan of my own.

While I missed my residents for the complicated patients, I missed them even more during the minute-to-minute ED moments. I felt lonely without someone to share in the excitement of making a rare diagnosis or someone to show a cool X-ray finding.

Education

Surprisingly, the thing I don't miss is teaching. Don’t freak out. I love teaching, and I think it’s something I do well. The reason I don't miss teaching is that I'm still constantly teaching. I work with scribes who are super-eager premed students dying for two minutes of teaching. Have you tried to explain an anion gap to a kid who is taking biochemistry? It requires an understanding of the science well beyond MUDPILES. It’s both fun and challenging to teach to their academic level.

I also work with many nurses who are working on their nurse practitioner degree. Once I know they are interested in education, I’ll take a minute to pull them aside and teach. I made the mistake of waltzing into my new emergency department and assuming that everyone wanted me to teach. Many nurses are receptive, but some are not interested in pausing during their busy day for “learning.” On a few occasions, my two-minute mini-lectures were taken as pejorative instead of well-intentioned. Asking the simple question, “Do you have a minute to discuss that patient?” has gone a long way in figuring out who is interested and who is not.