Discoveries Magazine

Cedars-Sinai

Warning: Learning Curve Ahead

Illustration: John Cuneo

Being a beginner is tough — and there is no exception for doctors. It doesn’t matter how smart you are or how talented you feel, when you are new to a job, you will trip over a hurdle or two. Here, Cedars-Sinai’s stellar caregivers and investigators reveal lessons learned during their first days in medicine as well as surprising tales of the superstar mentors, savvy nurses, and idiosyncratic patients who helped along the way.

Jeremy Falk, MD Associate Director, Lung Transplant Program

My first day of internship in the summer of 1998 was with a very busy heart failure service, and I was like a deer in headlights. Literally all the residents and fellows left for lunch and I was in the unit by myself when a patient had a cardiac arrest and went into ventricular tachycardia — a very fast heart rhythm that can be life-threatening. One of the possible interventions at the time was something called a precordial thump, which basically means that you strike the person’s chest and try to interrupt the rhythm. I had only read about this and didn’t really know what it meant. So I went into the patient’s room and very lightly tapped his chest. Of course, nothing happened. Then, after what seemed like an eternity but was probably about 30 seconds, a fellow came running from the other side of the room, made a fist, jumped, and slammed on the guy’s chest as hard as he could. Then I realized what a precordial thump was. And the patient was OK.

Ruchira Garg, MD
Director, Congenital Noninvasive Cardiology at the Guerin Family Congenital Heart Program in the Cedars-Sinai Heart Institute One of my first overnight calls as a pediatric intern was to insert an IV into a patient. It was 2 a.m. when I got a call from a floor nurse about a 9-month-old infant with a complex genetic underlying disorder who’d had lots of IVs in the past but whose veins were difficult to access. The IV team had tried over and over to insert the IV but couldn’t. I said to my senior resident, “Why are they calling me when they do this all day? What can I do?” And my resident said, “Ruchi, you don’t know what you can do until you try it.” We looked at this patient very carefully, every arm and every leg, and I got the IV in on the first try. It was very empowering. That resident taught me that you never know what you can add to help a situation. You have to try.

Jaime Richardson, RN Cancer Clinical Trial Navigator
Samuel Oschin Comprehensive Cancer Institute

When I was in nursing school, I did my labor and delivery rotation at a Jewish hospital (not Cedars-Sinai). My first patient was a young Orthodox woman. When she was in labor and bleeding, my nurse-instructor informed me that her husband couldn’t touch her, but he was still very close to her and talking her through the contractions. Pretty far into the labor, they wanted to pray in between contractions and requested to wash their hands. I ran outside and grabbed a bottle of Purell and then they explained to me, no, they needed a basin and warm water to wash their hands ceremonially. I felt like such a dummy! They probably were the same age or a little younger than I was, maybe in their mid-20s, and they giggled and were very sweet when I brought in the hand sanitizer. Then I provided what they needed and stepped out so they could pray. It was quite a lesson in cultural competency.

Bruce L. Gewertz, MD
Chair, Department of Surgery Vice President, Interventional Services Vice Dean, Academic Affairs Director, Division of Vascular Surgery Surgeon-in-Chief H & S Nichols Distinguished Chair in Surgery The memory is still fresh in my mind more than 40 years later: I was a fourth-year surgical resident at the University of Michigan, shadowing an experienced endocrine surgeon named Norman Thompson. These were the days when you could smoke in the hospital, if you can believe it. He would walk into a patient’s room, pull up a chair, and start a cigarette. He’d spend the next several minutes chatting about a patient’s surgery, listening to her fears, and answering all of her questions. The patients were so grateful that he would commit like that — that he was really present and invested. Those conversations were an extraordinary lesson about the power of empathy and compassion.

Shervin Rabizadeh, MD, MBA Director, Pediatric Inflammatory Bowel Disease Program
Director, Division of Pediatric Gastroenterology Medical Director, Children’s Health Center
My residency was at Johns Hopkins, but sometimes we would go to a small community hospital to serve as residents on its pediatric floor and the baby nursery. On my first day there, an attending neonatologist gave the interns a 10-minute lecture on how to examine a little baby. We learned that if the heartbeat is more prominent on the right than the left, it might indicate issues such as a collapsed lung. But this is extremely rare. That very afternoon, I was examining a baby and I said to myself, “Wait a minute, this heartbeat is so much stronger on the right than the left.” I thought to myself, “Nah, come on. It must be a figment of my imagination, because this is so uncommon.” But my co-intern agreed with me. Nervously, we called the attending doctor and she said: “No way, no way. Fine, I’ll come over.” But she examined the baby and started to think we were right. We got an X-ray, and the kid did indeed have a collapsed lung, which we treated. Some things you just learn on the job right away. 

Bradley T. Rosen, MD, MBA
Vice President, Physician Alignment and Care Transitions
Medical Director, ISP Hospitalist Service Medical Director, Supportive Care Medicine
A code blue is when a patient has some kind of cardiopulmonary arrest or requires heroic intervention to save them. One day during my first month of internship, I was part of the code team, led by a third-year resident. This code went on for probably 30 minutes. We tried and tried to get the patient back, but eventually the resident “called” the code; we were no longer going to attempt resuscitation and the patient was pronounced dead. There is this uncomfortable moment in that situation when everything stops and you’re in the room with a newly dead person. Staff started filing out and I remember feeling very sad and confused. I walked up to the resident and asked, “What happened? Why did we stop?” He took time to pull the code team aside and we talked through the whole experience. I found that to be such a human moment. It stuck with me because it was a nice way to reflect upon the seriousness of the work we do — and how to cope with death and with moments when we can’t help someone. When I train interns now, I am still mindful of how new and terrifying everything is to them. I try to keep it light and be supportive at the same time.

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