INNOVATION AND CHANGE
patient ’ s very sense of sight was entrusted to that OR team .
I was exposed to court cases where Dr . Rychwalski testified to the presence of retinal hemorrhages in an abused infant . I remember a morning when a child with strabismus yet again failed to show up at pre-operative registration , her parents slowly increasing the likelihood she would develop amblyopia . I saw Dr . Rychwalski ’ s interaction with residents and the special care those young doctors exercised when examining and operating on his patients .
Accompanying residents to the emergency department , I learned how to approach a traumatic injury to the orbit . When a close friend arrived at my home minutes after a blow to his globe by a ceiling fan , I called Eric Schweitz ( one of the residents ) and met him at the University of Louisville ED . After “ pimping ” me throughout the examination , Eric allowed me to suture my friend ’ s eyelid lacerations . At all times I felt welcome and appreciated .
I soon became involved in research with Dr . Rychwalski . I composed a case report on a 5-year-old with a hypoplastic medical rectus muscle , another on infantile neuroaxonal dystrophy , and helped initiate a study investigating the surprising percentage of unnoticed microstrabismus among physicians . None of these projects has yet achieved publication , but I was more interested in the experience . The flow of information from mentor to student was rapid and multifaceted . Of course , many of the lessons I learned had less to do with the eyeball and more to do with medical training , balancing family life and the maintenance of integrity in an emotionally demanding field .
As I progressed into the detached gap of the preliminary year ( in Internal Medicine ), I found myself asking for extra intensive care months and spending curious amounts of time in the trauma resuscitation room . Halfway through my first year as a doctor , I was serendipitously assigned an elective in the emergency department . Eight shifts ignited a passion that could not be quieted .
Despite the wise predictions of those close to me , I had smoothly matched in the specialty of Ophthalmology . I had planned to capture the contentment and academic wonder I saw in Dr . Rychwalski and his fellow faculty members . My mentor had been too effective , if such a thing is possible . The interpersonal and idiosyncratic connection that distinguishes a mentor from a teacher was strong enough to convince me that I was interested in a specialty that in other circumstances I might not have been .
Initially I was overcome with a feeling of contrition , resembling guilt , when facing the fact that I had chosen the wrong career path . This emotion toggled with a cathartic sense of fulfillment when I experienced the same visceral excitement that I saw in my wife when she performed her first obstetric delivery . Within two weeks I approached the administrative physicians of the Ophthalmology Department . The chairman , Dr . Kaplan , was as always courteous and professional when I informed him of my decision . Dr . Soltau , the program director , respectfully expressed surprise and regret that I was releasing my position .
However corny , I now find myself excited on the way to work where I am surrounded by brilliant , industrious , enthusiastic mentors . With a different attending and upper-level resident on every shift , I am exposed to novel physical exam maneuvers and procedural techniques . The diversity of backgrounds among the Emergency Medicine faculty makes available a variety of teaching styles and ensures well-rounded training . I have not yet found an attending with whom I had difficulty establishing a reciprocal relationship .
Reviewing every resident ’ s charts , Dr . Coleman ensures that we do not repeat mistakes and we do repeat successes . Dr . Price teaches us to be assertive at all costs when patient care might be compromised . At the end of didactic lectures , Dr . Vicario elucidates difficult clinical scenarios with countless vignettes . Dr . Mallory attempts to teach what might not be learnable : the ability to discern a complex set of physiologic derangements just by the overall appearance of a patient . In chaotic environments , Dr . O ’ Brien has shown me how to quickly prioritize a group of patients based on level of acuity . With enthusiasm , Dr . Smock prepares us for disasters and “ pimps ” residents on the ever-important yaw . (“ Yaw ” might be familiar to you from NASA . Here it relates to the physical forces created in the body by a projectile . For instance , if a bullet travels sideways through the person ’ s tissue , it has more yaw .)
With unwavering patience , Dr . Platt helps fill our inevitable gaps in knowledge ( as if she knows the feeling ). Dr . Orthober illustrates how to achieve simultaneous success in 12 jobs , including the field of Rock Stardom . In toxicologic emergencies , Dr . Bosse reminds us of the relevance and beauty of biochemistry and pharmacology . And , of course , Dr . Danzl proves that this profoundly researched and described field of medicine has not antiquated the term “ human encyclopedia .”
In the transition between programs , I was most anxious about meeting with Dr . Rychwalski . I vividly remember walking into the same office I had visited as a patient in my first year of medical school . He was at once typing on the computer , listening to a parent on the telephone and talking to one of his nurses . He respectfully finished his other business and gave me full attention . Before I spoke , he could see the hesitation in my face . He assuaged my anxiety and patiently listened as I bluntly admitted that I had chosen the wrong medical specialty . With a look of support and absolutely no astonishment , he said “ OK .” Like other friends and family , he expressed happiness that I had found my true vocation . He exhibited no regret for spending valuable time and energy preparing me for residency and my role as a physician . At the end he smiled , shook my hand and insisted that I not become a stranger .
Dr . Huecker is an Associate Professor and Research Director in the UofL Department of Emergency Medicine .
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