Crozet Annals of Medicine: When to Worry

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I spend a lot of my time at work watching other people work. This may sound like the ideal job, but for an ER doctor used to moving quickly it can be excruciating. Watching a trainee slowly close a wound with imperfect suture technique can be like watching a slow-motion train wreck. I slow down my breathing, bite my tongue and wait for the proper moment to intercede. Gently, gently I remove a few errant stitches, replacing them with care and turn the task back over to the chastened intern to complete in a more practiced manner.  

Watching does not come naturally to most ER doctors. By nature we tend to be focused on action, on doing something, anything. I have consciously developed my tolerance for waiting, for watching, over many years and I think I have gotten better at it. It has made me a better doctor and a better teacher as well. Sitting still, silently watching can be so revealing of a larger picture obscured by too many small attentions. 

I was thinking about this while stuck in an airport recently, waiting for a delayed flight. I wasn’t too upset by this delay. I had built in generous time buffers to my travel plans in order to minimize my stress levels.  With nothing much to do for several hours, I found myself avidly watching the bustling of the throngs around me. Everyone was hurrying and stressed, as people at airports tend to be, worried about catching flights, missing connections, lost luggage and bad food. I had a book to read but for some reason watching everyone else worry about things I was not worrying about was more interesting to me and somehow instructive. It was clear to me that the stress in the terminal was contagious. Indeed, a large body of scientific study shows that rudeness and stress in medical teams are both contagious and corrosive to effective performance. It was also clear to me that most of the worries in the terminal were unwarranted. No flights had been cancelled and almost everyone was getting on planes in plenty of time. As my wife often reminds me when my stress levels get too high, “I’ll tell you when to worry!”   

I was at gate 7. My flight had originally been scheduled for this gate but the gate had changed several times with each delay and with no time pressure I simply had neglected to move to the new gate. An anxious woman approached me. I guess my placid observational mien made me look approachable or knowledgeable or helpful. My ER residents often make the same misplaced assumptions.  

“Are you going to Philadelphia?” she asked me. Her gate had been changed to gate 7 but it had not yet appeared on the display and she was worried that she was in the wrong place. 

“No,” I answered back. She looked at me, clearly puzzled.

“Then why are you sitting here?” she demanded. 

I thought about it for a few beats and said, “I got tired of standing.”

She stared at me for a moment, as if trying to assess my mental fitness, and then burst into laughter. 

“Sorry, it has been a stressful morning,” she said. I gave her a smile and went back to my watching. She sat down, visibly more relaxed. After thirty years in the ER, diffusing others’ stress comes naturally. So do the wisecracks. 

And come to think of it, after thirty years in the ER maybe I should be the one to tell you when to worry. 

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