Reflections on Training
A “few” years ago, when I was a pediatric resident on my ICU (intensive care unit) rotation, I witnessed a lesson about knowing one’s worth. I was in the early stages of finding my way around the pediatric ICU, learning the routine, and getting to know the ICU staff and personalities. I was ultimately trying to understand the many aspects of the pediatric ICU that make it a little overwhelming for a young pediatrician-in-training. I had no idea that I, myself, would eventually settle on a career in pediatric critical care medicine as a pediatric intensivist (pediatric critical care physician) and spend a great deal of time in the pediatric ICU over the following 20-plus years. I learned may things on that rotation. But, I observed an important interaction that has stayed with me to this day, serving as a lesson about knowing one’s value and worth.
At the time, I was still trying to understand how to differentiate a critically ill child from a sick child in the hospital setting. The pediatric ICU rotation was the foundation of that training. A children’s hospital is full of sick kids with a wide variety of diseases from malignancy to congenital heart disease to trauma to infection, as well as many other maladies. But, there are subtle signs of critical illness that raise a pediatric intensivist’s suspicion that a child is sicker than the usual hospitalized child and they need to be managed more aggressively in the ICU. The primary job of the pediatric intensivist is to anticipate, identify, prevent, stabilize, and treat critically ill children. However, the basic delineation of a pediatric intensivist’s job description is sometimes lost on others outside the specialized field who may consider themselves prepared for the critically ill child, even though they may not.
Witnessing a Lesson
I remember a child being brought back to the pediatric ICU for post-operative care after receiving surgery for a perforated appendix. Appendicitis is an inflammation of the appendix that may or may not require removal of the appendix. However, if the appendix perforates or bursts, there is a significant risk that leakage of the contents from the intestines can spread into the abdominal cavity and precipitate an infection in the abdomen. This infection can spread to the rest of the body in an overwhelming infection called sepsis. The perforated appendix needs to be removed and the patient requires meticulous care to prevent sepsis.
However, in this particular case, the child rapidly became septic after returning from the operation and developed septic shock. Septic shock is the extreme end of the sepsis spectrum where the different organ systems become affected by the overwhelming infection. The blood pressure falls, the kidneys may not function appropriately, and other organs may be adversely affected. It is a life-threatening condition, and one that pediatric intensivists are specifically trained to manage.
As the pediatric intensivist supervising the ICU at the time was preparing to intervene, the non-pediatric critical care physician, who brought the child back to the pediatric ICU, began barking orders and figuratively pushed the pediatric intensivist out of the way to manage what he perceived as only “his” patient. He did seem to want to share ownership of the patient at that time with his pediatric intensivist colleague and sought to manage the child’s care by himself, not taking advantage of someone who had spent their career training for such a critical moment.
Did this other physician not trust his pediatric intensivist colleague? Did this other physician not understand what a pediatric intensivist’s job was? Did this other physician not value this physician whose career was dedicated to caring for the sickest of children? I don’t know what was going through this other physician’s mind, but I did witness how the pediatric intensivist responded and the image was seared into my memory.
Stepping Back
The pediatric intensivist did not argue. He did not attempt to take control of the situation. He did not push the other physician out of the way. The pediatric intensivist just calmly stepped back, leaned to one side of the inside of the doorway to the patient’s room, crossed his arms, and patiently waited and intently watched the situation unfold. He observed what was happening and saw how the other physician was struggling. I could see in his eyes that he understood what was happening to the child and I saw the confidence in his demeanor. It was not an overconfidence. It was just a posture and presence of knowing his own value and not allowing another to diminish it.
It seemed like an eternity, but it was only a matter of minutes before the other physician realized that he had underestimated the complexity of the scenario and overestimated his ability to deal with it. He looked back at the pediatric intensivist with a panicked look and the pediatric intensivist asked him, “Are you ready for my help?” The other physician gave a brief nod in agreement and the pediatric intensivist rapidly stepped in to orchestrate the resuscitation.
He calmly communicated with his staff, displayed team leadership, enacted the appropriate interventions, and eyed the patient’s monitors like a hawk while examining him throughout this most critical phase in the patient’s illness to stabilize him. When it was all said and done, I could see the two physicians talking and I perceived a sense of relief on the non-pediatric intensivist’s face. The pediatric intensivist’s posture and behavior was not that of arrogance or of someone who was gloating that he had done what the other had not been able to do. It was the appearance of someone who had just done their job and was happy that things had turned out well.
Appreciating the Significance
While I’ve replayed this event in my mind many times since then, the significance of it and my interpretation of it has changed as I became a pediatric intensivist myself. In my mind’s eye, I understood that the pediatric intensivist had not put the child’s life at risk by waiting and letting the other physician flounder. He had given the appropriate amount of space and time to allow the other physician to realize his colleague’s value and worth. The pediatric intensivist knew how to salvage the situation and was confident in his abilities and training to do just that.
Lesson Learned: Recognizing Your Own Value
The pediatric intensivist’s own self-confidence was a lesson to me to not let others determine your own worth or value. This life lesson’s importance became more apparent as I matured and came to realize what I brought to the table in the medical field and in life. We all have something to contribute, and we shouldn’t be defined or devalued by others. If you don’t acknowledge or know your own worth, others won’t see it in you either. However, sometimes, you must resist the urge to convince others and just confidently step back to let them come to the realization on their own about how much they actually require the expertise and experience that you have to offer.
Have you ever found yourself in a position where others didn’t fully appreciate your skills or knowledge? How did you handle it, and what did you learn from the experience?
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