For some that finish their medical training, academia calls them to stay and serve, whether this be as educators, researchers or both. However, for many others, completing medical training means to be cast out far into the open ocean in private practice, underserved populations or sometimes very rural situations. In either case, maintaining professional and personal relationships is not only something of politeness, but also sometimes of shear necessity, especially as one dives farther into the unknown.
If it’s not abundantly clear what I’m talking about, it’s the question of what to do when you don’t know what to do. In academic settings in big cities, specialists are at your fingertips, sometimes even in the hospital 24 hours a day or at the very least a short distance away. It is so easy to make referrals, even if they won’t be seen temporally due to schedules, they’re down the street, maybe just on a different floor. For questions or concerns, the longer you stay within the safety net, the easier it is to call up a friend and run difficult cases or situations by them – nobody knows everything and the importance of teamwork for me on the level of consultation can NOT be understated.
But, for those of us that leave the nest, sometimes things become a bit more difficult.
Being a locum provider and leaving my training setting has been eye-opening as I find myself in different communities where it is not as easy to get this subspecialist help, and yet, as I find myself floundering in the water, new friends continue to pop up and offer their help and it reminds me, that even when I am alone, I am not totally alone, but I just don’t know it yet. I have needed to transfer patients to other hospitals where the resources supported a higher level of care and in doing such have spent a lot of time talking to more experienced/more acute intensive care specialists. I have picked the brains of my flight teams and paramedics on different policies and practices in different cities, states and conditions. While I know my home institution is only one phone call away, I have had to learn in certain parts of the countries who was the local help and who to triage my questions with in each unique setting. As much as I love to call Texas for help, sometimes in Maine, you need to talk to Maine. Protocols differ from institution to institution as do safety net programs from state to state.
My favorite part of this journey in the wild has been my interactions with all of the fantastic transport teams all over the country. Whether i’ve needed to ship a subgaleal hemorrhage from 45 minutes near the US-Mexican border via an airplane, or needed help with a baby I intubated int he desert of New Mexico, or a chest tube in Maine, I have had such a positive amazing experience being on this side of the table. I have gotten help from helicopter teams, ambulance teams and even an airplane. I’ve met amazing nurses, respiratory therapists, paramedics and neonatal nurse practitioners that have helped to save so many of my disasters we’ve come across. They have taught me so much and it has opened my eyes to experiences I couldn’t have ever thought of. I spent so long on the other side of the phone and being able to be on this side in the desert asking for help has humbled me deeply.
It’s a scary world and I am constantly grateful for everyone that has helped me move along to keep children healthy and save lives. Always keep track of and good graces with those friends in the higher places, especially those that come to help when there’s noone else nearby to do it.
The Nomadic Pediatrician 