Crozet Annals of Medicine: Times Change

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Not much happened in the ED this month. A late resurgence in flu cases caught us by surprise. Medicines continue to be in short supply—particularly IV narcotics. In a narrow sense, this has an upside. Our interns and residents are learning how to practice using far fewer strong opioids. They are finding, to their surprise, that most painful conditions can be adequately managed without IV narcotics. If these shortages persist we may end up back where we started decades ago, using IV narcotics only for severe pain and suffering. Indeed, one of the advantages of being in the late stage of my career is being able to take a long view and also to reflect back on decades of practice. 

Sometimes I don’t have to reflect, though; the past actively catches up with me. For example, I heard from several of my old residents this month out of the blue. The first was in the form of an email:


Long long time, no hear…

Almost twenty years, but believe it or not I was just thinking about you in preparing a talk at an EM conference in Australia. I remember some profound advice you gave me as an EM resident at UVA… “in a pissing match, there’s always wind…”

I’ll be passing on these words of wisdom but I’ll give credit where it is due.

Hope all is well back in Virginia.

Well, it’s nice to be remembered for something. It made me chuckle. Later that week two former residents stopped into the ED 20 years after they graduated from our program. They are married now and had their oldest daughter in tow, doing a college tour of U.Va. They looked virtually the same. They assured me I did too. Memory is a funny thing.  

They asked after all of the old faculty and asked me to pass along to them all how deeply grateful they were for the training we had given them. It had guided them their whole careers, they told me. Well, that was certainly nice to hear. I passed it along to the faculty who were there back then. It was a lovely reminder of why we do what we do.

Just to keep me humble, though, they did remind me of their graduation roast of me, portraying me in a skit as blithely reading a novel on the night shift while the ER crashed all around me, leaving the residents to their own devices. This may or may not have been an accurate portrayal of my management style 20 years ago, but I told them I no longer bring novels to the night shift. Times have changed. I have the Internet now.


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