When In Doubt


October 1, 2017

There was a time in my life when I was meek and quiet. I sat at the front of a classroom, stood at the back of a group of people. Somewhere during residency I became a different person.

Some time in the course of becoming that person, I was standing in the emergency department, two other youngs docs beside me, my idolized faculty physician holding court before me. He wasn’t a giant in stature, but he was in personality and intellect. I was forever in awe of him and terrified I would screw up on his watch because that was usually met with a tirade of beratement reminding me, or whoever else might have made a mistake, that our misstep could cost others their lives. I didn’t need the reminder of the gravity of my choices, but I was worried about earning this doctor’s respect. He was brilliant and commanding. He stood up for his patients and got them what they needed, all bark and bite when needed — -gentle kindness or welcome humor as necessary. He was the kind of doctor I hoped I could be.

During our time as residents in the ED, this doc (we’ll call him Dr. D.) would take every opportunity to teach us. He would give us the interesting patients, pull us in for procedures, and quiz us in the down times when there was nothing else to be done. This particular day, as I was becoming that different person, my compadres and I were enduring the quizzing.

“You have a 74-year-old white female who comes in with palpitations and dizziness, she’s going from the wheelchair to the stretcher when she passes out. What are you going to do?” Asks Dr. D.

My wheels start turning. Situate her on the bed. Get her on the monitor. Assess the rhythm. Get IV access… I wait for one of the other young doctors to answer. The air thickens to the point at which I must answer because I can’t breathe.

“Get her on the bed and onto the monitor…”

His imaginary situation worsens, “You get her on the monitor, and she’s in v-tach. What’s next?”

My hands get clammy, and I break out into a fine sweat across my upper lip. Our patient has reached that place at which decisions have become life or death. I gave the first answer, so the unspoken rule of the nerds is that someone else steps up for the next one, but somebody has to check her pulse.

I study a mark on the floor while my face reddens. Finally an unsure voice to my left mutters,”I guess we need to check a pulse and make sure she’s got one with that rhythm.”

Dr. D likes boldness, and I’m pretty sure that he feels like he’s pulling teeth with this exercise.

“Alright!” The small giant sighs. “She has a pulse, but she looks like death. She’s clammy and pale, and she’s still not responding. What are you going to do?”

I’m pretty sure at this point that I’m as sweaty as our imaginary patient. We’ve got to do something now. The light is coming for her. I glance sideways at my colleagues and see uncertainty.

“Come on, Doctors! You’ve gotta move, or she’s going to die. What are you going to do?!”
How this man who is roughly my size seems so much bigger than life is beyond me, but he stands there with his hands stretched out in front of him, looking from one of us to the others, striking fear of disappointment in my soul.

He turns to me. “BA….” He starts and then cocks his head to one side. “Wait a minute. Can you say ‘balls up!” to a woman?…”

Then straightening up and sporting a shit-eating grin, “Aw, hell, you’ve got bigger balls than any of your faculty over there. BALLS UP, ADAMS! What are you going to do?”

And just like that, I got one of the best compliments I’ve ever received, but with it came one of the greatest lessons.

After the scenario completed and we had “saved” our patient, Dr. D takes us through a debriefing. One of his first questions is why the answers were so slow to come. Our answers are all similar. Each of us was afraid that our chosen action would make matters worse. Holding a life in one’s hands can do that to a person.

“Sometimes you reach a point in a patient’s care when something must be done. Without it, that person is certain to die. Sometimes, exactly what that should be escapes us. In those long, hard moments, just do something.” This man is the caring one.

“I know this goes against everything you’ve been taught,” Dr. D says, “but I promise. Sometimes you just have to do something, anything. That something could very well be exactly the wrong thing, but it will likely affect the course of events in such a way that allows you to choose your next move. When in doubt, just do something.”

Throughout my career, I’ve seen many moments when I was frozen with uncertainty, and this voice whispered in my ear.

“Just do something.”

Mothers and fathers spent more days with their children because of this lesson. But its reach was even broader because life has that way of being uncertain. As I’ve faced seemingly impossible decisions in life, when I’ve been anything but confident of my next move — then, too, these words have rung true. I might not have always known the right choice to make, but making a choice and moving forward with it has always eventually led me to where I needed to be.

When in doubt, just do something.

This story and all related material are the original works of Estora Adams. All rights reserved.