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A case of medical deja vu

June 2008

I began my hospitalist career at a community hospital in the suburbs of Washington, D.C., as a neonatal hospitalist.

I was drawn to the job by a combination of things: wanting to stay in the hospital, not the clinic; opportunities to do procedures; regular shift work. Probably the same reasons many of us go into a hospitalist subspecialty in the first place. (Yes, it is a subspecialty, even though we don’t have a board that takes obscene amounts of money so we can hang a yellowing certificate on the wall.)

I remember my first day on the job. I walked into the hospital with that mixture of eagerness, nervousness and arrogance that many new residency graduates probably feel. I was ready to take on the world and change health care with my bold actions, convinced that my intellect was superior to whatever I would find “in-house.” After all, I had trained at a humongous academic medical center. I had seen everything: traumas, exotic infectious diseases, open heart surgeries. Whatever a little suburban hospital could throw my way, I was ready!

I was pondering the job basics, like where I would find scrubs and if the physicians’ lounge had ribs or shrimp for lunch, when the elevator door opened. That’s when all hell broke loose.

I saw a pregnant woman being wheeled toward the operating room. Three nurses were frantically pushing the gurney toward a pair of doors that looked like the entrance to a restaurant kitchen. One of them turned and yelled, “Are you the new hospitalist? Come on! We have a STAT C-section! Twins!” Needless to say, it took me a second to relieve the pressure shutting my sphincter (you know which one) and jump into action.

I ran into the physicians’ locker room to change into scrubs. In my mind, the algorithm for resuscitating newborns merged into a prayer to St. Jude the Apostle, patron saint of lost causes.

First lesson in an emergency situation: Check your own pulse.

I did. I took a deep breath, splashed water on my face, looked myself in the mirror and said. “You’re ready. Go!”

I went into the OR. Nurses, techs, doctors were swirling around in controlled chaos. Voices were loud, but without the nervousness I anticipated.

The pregnant mom was in the middle of the room, already draped. The anesthesiologist gave the thumbs up to the OB, and the cutting began.

I walked slowly toward the warming table. I checked the oxygen, the heat, the suction. The NICU nurse looked at me, and, with a smile in her eyes, said, “Welcome.”

I looked around, and was happy to see that the neonatologist was there to help with one of the babies. She gave me a nod of reassurance as she was getting ready.

Then I heard the first cry.

Suddenly, a bluish, gooey thing was deposited on the warming table. It cried, it moved. A baby!

A switch went on inside my head.

“I have been here before. I know what to do.”

That’s when I realized that medical training is all about deja vu. Residency is a rehearsal for the drama you will act out countless times in your professional life. The purpose of training, I finally understood, was to face your deepest fears, time and time again, until they are not fears, but experiences.

The NICU nurse and I dried the baby, warmed him up, applied blow-by oxygen, checked the pulse and gave good Apgar scores. The baby cried and turned pink. As I turned around to tell the mom, the second baby came out. I gave the other half of the team time to do its job and to make sure the baby would “fly.” She did.

I approached the operating table. Mom was slightly dazed, and dad was pale as a ghost.

I put my hand on dad’s shoulders and, looking at both of them, said, “Congratulations, your babies are doing great.”

Dad seemed to snap out from a trance, and, with teary eyes, said “Thanks.”