Last night, a resident stopped me and asked if I would like to shadow her.  I’ve shadowed many of the attending physicians, residents, and nurse practitioners in the ER before, but today was different.  She saw patient after patient after patient in order of their arrival.  She ordered bloodwork and pertinent scans. She painstakingly recorded each patient’s treatment in the hospital’s gruelingly insufficient electronic medical records system.  She couldn’t find a patient’s nurse and was chewed out (jokingly) after forgetting to tell said nurse that the patient moved to the dialysis center (the disappearing patient act). She completed each banal, yet important step in her patients’ care with ease and good humor.

What was unusual about this resident was her interaction with her patients.  Each exam was a true dialogue between her and her patient – a verbal dialogue between her and the patient, and a nonverbal dialogue between her and the patient’s body.  Abraham Verghese has spoken extensively about the value of “a doctor’s touch,” the hands-on examination of a patient, regardless of whether it is crucial to their forthcoming diagnosis or not. It is about the intimate relationship of trust and security between the doctor and patient, a relationship that is, more often than not, completely lost in the faceless realm of emergency medicine.  This resident, who was as pressed for time as all her colleagues, successfully achieved this relationship with nearly every patient she examined.  They felt cared for.  This should not be an unusual experience.

The ER is a tough place for anyone to work.  Some might argue (as a resident on an emergency medicine panel discussion I attended did last week) that jadedness is a prerequisite to becoming an ER doc, that you can’t survive the quotidian trauma without acquiring a certain level of numbness. It is self-preservation.  Yet seeing the resident examining today’s patients is proof to me that these truths can coexist.  It is possible to cultivate the art of doctoring, to make a patient feel cared for, while working in the high stress, high stakes realm of the emergency department.  This resident, the hands-on examiner and compassionate multi-tasker, is the kind of doctor I admire.