“Within seconds, the sunlit sky above them had turned dark. Whitecaps sprang up on the water, and sheets of rain began to batter the boat. Fraizzoli hurried to release the jib as Morgan jumped up to get a life jacket from the cabin. Before she could grab one, a powerful gust slammed into the boat, tilting the sloop onto its side and sending the mainsail into the water. As the boat tipped, Morgan lost her balance and tumbled onto the rail. Looking facedown into the waves and fearing the boat was capsizing, she made a split-second decision—"I'll be safer in the water" and jumped into the bay.”
In times of trial, peoples’ hearts are revealed. It is not enough to say we are here to heal people. Something motivates all of us to pay for years of school, treat ungrateful patients and wrestle with stupid computers. If medicine is just a job, we might be tossed overboard by the first substantial wave. We are here to be part of something great and greater than ourselves, healing people and using our skills.
At the efficiency conference back in January, they said people need a “burning platform” underneath them, or they will never “jump.” Do you feel such a motivation? I know there are some people who disagree, but I believe most of us feel the yearning to fix this place, to quit tacking against the wind.
“The future is here, it’s just not evenly distributed.” Rather than paint a negative picture, let me talk about the working example we already know. The East Wing, where you don’t waste so much time looking for each other, wandering around the department. The East Wing, where there is a HUC always in EPIC. The East Wing, where there is a tighter, more efficient work environment. The East Wing, where patients are seen and discharged more quickly. We all love it there because we’re all here for the same reason.
Paradoxically, the spread of “East Wing Style” comes by the sacrifice of the actual East Wing as we know it. Six beds, two nurses, one tech, a doc and a HUC can be great, as we all know firsthand. The only enemy here is geography: we can’t do care teams anywhere but in the Main and the East. We have to tear apart 10 through 17 and put them back together again, but it’ll be worth it.
Now I’m no nurse and I’m no doctor. I’ve been manning the ER desk for eight years. I’ll be so sad when my ER time ends, because I have found out how to be excellent at something worthwhile and enjoy it. My job is instantly gratifying. And after six hours, two or three codes and fifty patients, I used to get into “the zone”. Everything was automatic and I didn’t even have to think about what I was doing. The doc walked out of the room having intubated, and the portable chest was already ordered stat. The nurse came towards me with blood, and I had labels and a Ziploc ready. The techs’ questions were answered before they formed on their lips. Expectations were known and met.
Care teams are the orchestrated version of that. Nothing is worse than a system without clear roles and rules. A well-defined system makes it’s easier to succeed. Done right, I would prefer to work on a care team than anything else! I want to keep all my patients in my head at once, and anticipate all your needs before you know you need them. Care teams mean we can make each other great, doing better medicine. We are sailing into bumpy waters, so baton down the hatches and remember why we are here. And let me collect that blood for you.
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