Sometimes I wonder, what makes me feel most alive these days?

Is it running a resuscitation successfully?

Is it caring for my sweet children?

Is it swimming again during Masters’, after years of avoiding the pool?

Is it time off with my husband, doing something we enjoy?

Yesterday I felt it.  I finally felt that rush of being present, alive, in the moment.  It happened most unexpectedly, as I walked out into the cool, dark evening air after a committee meeting at the university.  Suddenly, I felt transported to a time when I was free, without responsibilities, without anxiety, without a ticking clock.  Walking down the steep hill with the city spread out before me and the twinkling lights of dozens of cars, shops, apartments, police cars, lit up my insides like nothing has in a long while.  Perhaps it is because I made that same walk so many times, during my medical school years, and each walk back then felt energizing.  I felt, then, that I was working towards the end goal: physicianship.  I had purpose, direction, and my brain was on fire with learning.  My soul tingled with anticipation of the future.

I often find myself missing those feelings, the joy, the wonder, the vitality of being a student.  These days, I am the teacher.  I am the one imparting the knowledge to others.  A few weeks ago, I was the staff evaluating the medical students’ case presentations at teaching rounds.  Watching their faces light up with the excitement of discovery filled me in turn with happiness.  I felt fulfilled by the fact that the students were so intrigued by their cases, their patients.  It made me remember being in their shoes, and how full my heart would get when I finally solved a medical puzzle.

Recently, I worked with a very shy and quiet medical student who was nonetheless relatively competent after already having worked some shifts in the Emergency Department.  Partway through the day, we were called to the resuscitation room for a patient who was in cardiac arrest.  He was in his 90’s, had lived a full life, and had dementia.  He was found by a family member unresponsive, and the ambulance technicians had already been doing CPR on him for over an hour with no success.  When he came to our resus room I gave him a fighting chance; continued CPR, pushed epi a few times, but after not too long I chose to call the code after a discussion with his family in the room.  I pronounced time of death, and closed his eyes.  During this whole time my student and resident were both in the room, observing, as I narrated to them what the team and I were doing and why.  Afterward, I took the student aside to debrief, as the loss of life under our care is always difficult to process.  She admitted that this was the first time that she had ever seen a patient die.  She had been present at numerous resuscitations, but the patients had always survived.  This time, her luck ran out.  I was surprised at how unaffected she seemed to be, but I know that this is a defense mechanism.  I made sure to counsel her on talking about her feelings with friends or family after the shift, and told her that I am always around to talk to if she needs.

I know how it feels, to stand in the room and watch as a patient passes away, and not have the ability to save them.  I know how helpless one feels, as a student, resident and even as an attending staff.  I also know how the feelings of devastation, guilt, sadness, can haunt us if we don’t take care of ourselves.  Now, as a teacher in medicine, it is my role to help my learners get through these hard times as well as the good.  This, too, is enormously fulfilling.

Currently, I am the Site Director for the Emergency Medicine course at our hospital.  I am responsible for orienting, guiding, and evaluating our medical students.  I take this responsibility very seriously, and I enjoy it.  My goal is to take a green, scared medical student and pull them into the wonderland that I see as Emergency Medicine.  I want to turn them around, make them tap their ruby slippers and wake up to a new world, a place they want to lose themselves in because it’s so incredible.  I wish for them a month full of new things, challenging moments, and transformation.

Maybe that’s why I felt so content after the Clerkship Committee meeting.  I am finally involved at the undergraduate level, in helping to adjust and implement the medical curriculum.  I am now part of the system that I worked so hard to get into in the first place.  I am back in the “ivory tower” of academia; I am using my intellect and firing up neurons that were dormant during the last few child-bearing years of my life.  This feels really good.  This makes me feel alive.