Copyright by Turner White Communications, 1998, reprinted here with their permission.
When I was senior resident in the emergency department (ED), I had the good fortune to work with Michael, a junior resident with the courage of his convictions. Michael took a Polaroid of each of his patients and pasted their photographs in a shadow file at his primary care clinic. He stayed until 8 PM each night after the other residents had left the clinic by 6 PM. What was Michael doing? He was writing letters of medical necessity to the electric company so it would not turn off his asthmatic patient's heat, and he was writing to the telephone company so it would not stop phone service for a family whose baby had an apneic episode. He was organizing a bus trip to Washington, DC, to lobby for public housing and public health. He was convincing pharmaceutical companies to pay for the ipecac and shock blockers that we passed out to every family that presented to the clinic. He was calling the mayor to ask for a house for one of his patient's families— and the mayor provided it.
One night Michael and I were working in the ED when victims of a tenement fire, a kid with a plugged tracheostomy and in full arrest, and the victim of a car-versus-pedestrian accident all presented within the same half-hour. The entire ED staff poured out of their offices, and the department was suddenly saturated with attending physicians. Each code was run by a junior attending physician with a more senior attending physician also on the team. The fellows were running the airways, and the junior residents and I were left- and right-side physicians. Only one nurse and one clinical assistant were available per patient, so the interns were running back and forth with laboratory tests and supplies.
The emergency medical technicians brought in two 4-year-old boys from the tenement fire, and we ran the two codes side-by-side in the trauma room. I knew when these patients arrived that the boy on the right would live and the boy on the left would die. The boy on the left was in full arrest, had an intravenous line in place, and was already intubated. Michael started cardiopulmonary resuscitation on him. We repositioned the tube, placed a femoral line, took an arterial gas reading, administered round after round of epinephrine, and shocked the patient, but we couldn't get a rhythm. The junior attending physician who was running the code started to “talk the talk”—to drop hints that we would soon be calling the code—to prepare us for a consensus on futility. That's when I noticed that Michael was crying. I reached out to touch his arm, and he broke down and lost his rhythm.
“Get your hands off the chest,” the senior attending said to Michael in a tone of utter contempt.
Michael backed into a corner and stood crying with folded arms as a nurse took over for him. The child whose chest Michael was pumping had died from living in an unsafe apartment in the inner city. Michael knew the experience of growing up in a place like that, and that night he learned what it was like not to grow up.
I knew that the residency program had treated Michael with contempt for 2 years because he was not as organized and efficient as some of the other residents. I knew that this was his first week back from a several-month leave of absence from clinical duties. I knew that earlier that day, Michael had politely questioned our invasive management algorithm for a small infant with a fever. An attending physician in the ED had abruptly answered the question, “You're supposed to know that by now.” Afterward, Michael had said miserably, “He thinks I'm an idiot.” The attending who banished Michael from the code thought he knew Michael as a second-rate resident. The truth was, he didn't know Michael at all.
Before we called the code, I motioned for Michael to come stand by me. I put his hand over the child's femoral artery and asked him if he could feel pulses. I gave him my stethoscope and made him listen to the boy's chest. I stood with my arm around Michael and told him that it was a normal human reaction to cry. I don't know if he believed me. When the code was called, though, Michael was part of the circle, and his hands were on the patient.