Keep Calm and Check the Pulse

David K. Werho, MD

David K. Werho, MD

The trainee and junior faculty section of the newsletter is a place where pediatric cardiac intensivists in training and those who recently joined the workforce can contribute discussions or commentary relevant to those of us still getting our bearings.

As someone who just a few weeks ago finished my training, the most pressing question in my mind is; “How am I going to do this? How do I transition from being a medical trainee for the last 13 years of my life into a role where I’m now independent (though hopefully not completely on my own)?”

Since I have neither the knowledge or experience to answer this question, I did what I’m trained to do in such situations - ask for help. I’m extremely lucky to have trained with several dozens of skilled, thoughtful, wise, and helpful pediatricians, cardiologists, and intensivists who remain eager to help when they can. I asked them what advice they could offer and summarized their wisdom below to hopefully benefit others going through this transition.

Wellness and self-care are critical. This is not an easy profession; it does not allow you to rest on your laurels when you’re actively caring for some of the sickest kids in the world and it’s not without its toll. Burning bright at 110% all the time will consume anyone, so practice self-compassion. “You are neither weak nor powerful. Bad things will happen. Try to blame yourself less.” And take some time off for things that are really important to you.

In our field, we are both blessed and cursed to have lots of opinions about the work we do. Seek advice often, but when you’re making decisions, do what feels right for the patient. By its nature, we are a team-based subspecialty, so always be respectful of your colleagues.

“Be flexible. Learn your new system before trying to make changes in it. Avoid saying ‘At my institution, we did it this way.’ Although your past experiences are vital in helping you develop your style and way to do things, it is just as important to learn what works in your new system and then make changes that will be effective. Find several mentors. One person doesn’t have to fill all your mentoring needs. Ask questions frequently. I think I sat down with a senior colleague on an almost daily basis to rehash my decisions when I started.” -Catherine Krawczeski, MD

Your presence on the unit as a trainee, no matter how experienced, is different when you become faculty. “Although you won’t always feel like it, you are the leader of the unit. As such, your reactions… are taken to heart more so than when you were a trainee… Share compliments liberally (but be genuine) and deliver critiques gently and with compassion. Teach as much as you can — everyone wants to learn and often those who are struggling crave it the most.”

Pay close attention to your patients and give them what they need. Some patients will do well if you let them heal without tinkering, and some will not, despite everything that you do to help. However, there is a small subset of patients who really need your utmost attention, thoughtful consideration, and active, intensive doctoring; your job is to identify this group and do everything in your power to give them the best outcome possible. 

“Under the best circumstances, it takes at least two years for any new cardiac intensivist to begin to feel competent with clinical decision-making on most of the patients admitted to the CICU. Thus, it's not realistic to expect you will be on top of a unit full of active cardiac patients soon after completing fellowship. And even after many years of experience in cardiac intensive care, it's important to recognize that you are not truly in control of the clinical path of all of your patients. It's simply not a place to feel comfortable and relax your vigilance.” -Stephen Roth, MD, MPH

Finally, time is short, do not waste a minute, always show up, be visible, get involved and take chances. And when things are going south, take it one step at a time. Step 1: Keep calm and check the pulse. 

Thanks to all the mentors at NYU, Michigan, and Stanford that gave me sage advice and somehow turned me into a pediatric cardiac intensivist.

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