Stop Running

There’s a young man in green scrubs running from the hospital. He’s running along the sidewalk, focused look on his face. He’s not trying to keep the stethoscope in his pocket from flopping around, and he’s not trying to run away from anything; he’s not looking over his shoulder, he’s not looking around to see who sees him, he’s just running. He’s running toward the cheap parking garage nearest the hospital. This isn’t the higher-priced one where attending physicians park, and it’s not the free parking available to hospital visitors. It’s the parking garage used by residents and students. It’s 6:42 AM.

He’s really running—long bounding strides with both feet off the ground at the same time—and he’s fast. I see him quickly cross the quad, down the long sidewalk in front of the library, covering the equivalent of a city block in the time it takes me to walk a dozen steps. I know that run; I’ve run that run—though I ran certainly neither as gracefully nor as quickly as the young man I am watching now. It’s a run of desperation, of being caught between a rock and a hard place, of fear and determination and disappointment and panic and futility and hope beyond hope.

Just about any resident or attending surgeon recognizes that run: it’s the run of a medical student or resident who’s left their pager in their car, or maybe their patient list, or a thumb drive with a presentation they’re supposed to give. They’re a trainee who’s about to be late for rounds, one who needs whatever it is they’ve forgotten ten minutes ago, but who also has work to do that must be done before they meet their larger team, before they disappoint the chief or the fellow or the attending who will make their day or rotation or evaluation unbearable if they show up even once unprepared. This is a trainee who has a chief or a fellow or an attending who will find them unreliable if they show up even once late. This is a trainee who believes that this moment is about to ruin their future career because they forgot something in the vehicle they woke up at 4:30 AM to drive to the hospital for the twentieth day in a row.

At a cardiac arrest, the first procedure is to take your own pulse.¹

Running is great. Not for me, mind you, but plenty of surgeons and trainees run for fun, run for health, run for the challenge to their minds and their bodies—not terribly surprising, as many of us have been more figuratively running throughout our academic careers. This is the running Amalia Cochran and Luke Selby post about on Twitter, with pictures from marathon foot races and stories from marathon call shifts. This is the running that gets your blood pumping, your adrenaline spiking, and your smile gigantic when you see what you’ve accomplished.

But there’s this other running, too. The running we see in The Walking Dead, the run for your life, the panicky all-out sprint that’s more likely to give you a cramp than a quick finish. The run too many students and residents run. There’s no smile at the end of these runs. At best, there’s relief.

If this resident’s or student’s team is “enlightened,” they’ll tell the trainee to sit, take a breath, no worries, everything’s fine. If they’re outstanding, they’ll explain that this was the old way, that medical training doesn’t work that way anymore, that you won’t ruin your career by being late or forgetting something in your car, that they work as a team and have each others’ backs, look out for one another. This runner will still be uncertain, still be shaky, still have the adrenaline pumping and have difficulty concentrating on patients and education. This trainee will forget something, overlook something, or misspeak about something. The patients and the team will suffer more when trainees worry about their own suffering. This runner didn’t stop to take the most important pulse.

The one thing about this team that’s apparent just from seeing this run is that they haven’t told their trainees previously to stop running. Students and residents still think its necessary, think a single mistake is a sign of weakness, think they’ll never recover from one late arrival or forgotten list. As academic surgeons, quite possibly the most stereotypically unforgiving of obviously minor mistakes, it’s our responsibility to tell our teams, our trainees that they can’t be effective learners and caregivers if they’re in a state of fear, of panic. We have to be the ones to tell them, proactively: stop running.

References

1. Shem, S. (2010). The House of God (Reissue). Berkley.

Acknowledgements

Thanks to Brandyn Lau, Joseph Sakran, and JJ Jackman for valuable feedback and editing.