Locums Out of Residency: Trial by Fire

It was 544AM, I will never forget it. I was almost done with an unreal 72 hour shift in the hospital. I averaged 4 broken hours of sleep a night and left only to pick up food and occasionally go back to my hotel to shower. The sun was coming up on my last day and I was counting down the minutes until it was time to leave for a full break; and then, I got the call, “We need you. Labor and delivery room 411. ASAP.” I awoke in a confused fog, reflexively turned to throw on my maroon scrubs folded ready at the chair next to the bed in the call room, and put my cowboy boots on. As I tucked in my scrubs and grabbed my stethoscope, I opened the door to the call room, and immediately heard overhead, “Code Blue. Room 411.”

I started running. So many thoughts ran through my head as I groggily refocused and brought myself into full concentration – zero to a hundred, just the way I like it.

What could this be? Prematurity? Shoulder dystocia? Did the baby get stuck? Abruption?

I arrived at the room at 545AM to a crowd, there must have been 20 people in the room. In the bed was a new mother, alert, stunned, her doctor delivering the placenta. Across the room at the baby warmer i heard, “1 and 2 and 3 and breathe, 1 and 2 and 3 and breathe.”

Oh shit. They’re doing CPR on the baby, we need back-up… Wait, I’M the backup…

As I ran over to the warmer, and sprinted through the situation with the Family Medicine doctor that had just delivered the baby as I jumped for the tackle box full of resuscitation equipment. The heart rate was low, and not coming up.

I’ve never done this before. This baby could die. No choice, do it.

I grabbed the intubation blade and in one swoop and a single glance, I inserted the blade, immediately saw the vocal cords, was handed the tube from an assistant, and in a single try, intubated the baby. The heart rate improved with improving ventilation, the baby stabilized, and was eventually flown by helicopter to the nearest higher level children’s hospital, Alive.


Training to be a doctor has changed over the years. Decades ago, a third year medical student would have seen patients and prescribed medications with an alarming lack of supervision. Residents ran the hospitals at night time and the ‘Attending’ Doctors (those that had finished Residency training and were considered fully trained in their field) would often times not always be around for help. It forced an edge of education and responsibility, but within some phone call away of help. With time, due to liability, a focus on outcomes and likely accreditation, oversight has changed in the United States in regards to medical training. Often now, trainees are forced to discuss all of their plans with a fully fledged doctor. Intuitively, this makes sense. As a patient, I would want this. However, it often times means that the answers aren’t worked as hard for or that sometimes back up makes you comfortable, maybe even lazy. And, in my opinion, this lessens some of the forging that practitioners before me were faced with.

Don’t get me wrong, I had great medical training, but nothing had prepared me for my first Neonatal Code – it just doesn’t happen that often. I was lucky that it stopped at an intubation and didn’t require IV adrenaline or longer amounts of CPR; but, outside of mental exercises and mock codes, nothing could have truly prepared me for this.

I chose to do locum tenens to intentionally push myself beyond my comfort zone. I chose to jump out of the safety net of a big city and academic institution and hope that I would land in one piece. I have been forced to grow and take charge, to make increasingly harder calls and to sink in to the responsibility of doing what I do. In the short span of 2 years I have slowly decorated my CV and my procedure logs with similar situations that have pushed me to my limits. I have become a stronger leader, become more firm and simultaneously humbled in knowing that there is so much more to know. With each experience I grow thirsty for more and in my quest to become like those before me, I hope to continue going through the fire of the real world. Uninhibited, unbridled and uncanny, working locum tenens has put me in desolate places, in small places, in questionable places and I have continued to force myself to feel the burn of a ever scary feeling of unknown. One day, i hope I can look back on the amalgamation of all of these experiences and find myself a competent provider, but I’m not sure you ever can feel totally comfortable.

Image Credit: https://goodmenproject.com/featured-content/passion-is-forged-in-fire-kpkn/

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