One thing that is sometimes taken for granted in most ‘traditional’ jobs, is the ability for discussion and learning from peers and colleagues. Learning, can come obviously from multiple modalities and the way in which we grow throughout our life is influenced by so many different factors. With the time of COVID-19, learners throughout the world were forced to learn at home or remotely including those that realistically needed a “hands-on” experience. In medical training, simulation became key as a supplement for missing out on the actual situations that were deemed too unsafe for the learner to step foot into. In the world of Locum Tenens, what many from the outside sometimes overlook or are unaware of, is how easy it is to be stuck in a vacuum or practicing silently in a world removed from others. Most jobs needing a locum tenens provider, need them because there is noone else, which means, there is also noone else to talk to. How do you learn when there’s no one to teach you? How do you learn when low volume creates rarity? I’m talking of course of my favorite and most fearful concept referred to in many ways, but my acronym is: HALO Events = High Acuity, Low Occurrence situations. Now, I still think there is importance to staying uptodate on literature by reading case reports and institutions that allow providers to take part in grand rounds can continue some attachment to academic trains of thought, but the anecdotal component of medical learning is precious.

At my very first job as a locum tenens, one of the nurses (a Neonatal Resuscitation Program, a.k.a. NRP, instructor) started off my orientation by telling me about how less than a month prior to me starting they had a bad placental abruption – basically when the placenta prematurely separates from the uterus that can cause a life threatening hemorrhage, or bleed, for both baby and mother. When the baby was born the attempts at resuscitation were unfortunately suboptimal and NRP wasn’t followed by the leader of the Code. A heart rate wasn’t obtained until 20 minutes of life; unfortunately, although alive, the outcome required surgeries and a poor longterm outcome for the baby. From that debriefing I learned: The importance of a good leader is to listen to the team he or she leads, always stay ready and more importantly, always stay humble.

When I returned for months to my job in Maine after being away, I would hear stories of the excitement I had missed. I will never forget when Dr. P shared the story of a baby that was born “as pale as this piece of paper” that wafered in and out of being able to breathe. Immediate lab were sent amongst the routine NRP movements and returned showing severe severe anemia with a hemoglobin of 2 – something I had never heard of and never seen From the debriefing I learned about: Fetomaternal transfusions. The most interesting part was that more than 6 months later in Wisconsin, I was part again of a vicarious debriefing of a similar presentation without a placental abruption and a resultant baby born with a hemoglobin of 3; I suggested the diagnosis and the resulting tests suggested I was right.

In a small town in South Texas, as I was learning to perform Circumcisions, I recall discussing various methods with an old German doctor that had been in practice for decades. I had been trained in a less common method of administering anesthesia, subcutaneously, versus deep at the nerve root. I hadn’t heard of bad things with the nerve root block, if anything it was easier and superior for certain reasons, but it wasn’t something my mentor had trained me on. He told me of an unfortunate case in his training and from the debriefing I learned: Always aspirate (pull back) on the syringe you’re injecting deep lidocaine with, so that it doesn’t go into the artery… Otherwise you could have a Code Blue and Cardiac Arrest as Dr. W had witnessed decades ago.

As medical professionals, many of us discuss these cases, always of course maintaining confidentiality, somewhat to vent, somewhat to brag (just being honest) and somewhat to teach. It is physically impossible for every person to know or see every thing in one lifetime, and figuring out alternative ways to broaden our life experience is crucial to our practice but also important for our humanity. I share only a few of the thousands of stories that have impressed themselves upon me, but they are important and absolutely critical especially for the transient solo locum tenens worker. I caution dismissing or judging another’s story as hindsight is usually 20/20; but, I always encourage asking and discussing what’s happened. These conversations and learning points happen on larger scales at conferences, but the farther away you are from those big meeting and centers, the more important Story Time is.

Image Credit: https://www.vbdl.org/story-time-logo-w%EF%80%A2-girl/