After being out in the world as a Pediatrician having completed training for 3 years, it was mentally a gargantuan feat convincing myself that going back to Fellowship Training to become a Neonatologist was a good idea – 36 months of sleepless nights and endless work. Outside of the flexible schedule, endless traveling and high salary differential of locum tenens, being back in the mode of academia and facing a world of intensity and acuity I had left behind on sabbatical, was outrageously intimidating, to say the least. So, after years of dealing with healthy or older patients in largely less emergent or severe situations, my entire world caught on fire when I walked in to my first overnight call shift as a brand new Neonatology Fellow and a 1 lb (~500 gram) baby born just shy of 23 weeks of pregnancy went into Cardiac Arrest and the unit turned to me for Direction as my Attending stepped away to urgently call a consultant for alternative advice. I felt the eyes upon me as her heart rate dissipated, stood tall and took the reigns as best as I could. The last time I had done this or even taken care of a human this small? Never. But, before I did locum tenens, there were many Nevers.

It was hard restarting fellowship after taking a mental lapse in education. It was hard to jump back into medical knowledge I had lost and to resume time as If it had been only the day or month before that I had dealt with heavy subject matter and complicated physiology. I remember stumbling upon the ventilators that night staring at the numbers unsure of what most things meant. It was hard to take a big break in school and to let years of information slip away into the archives of my brain. I tried to dust things off as fast as I could going into that call, but nothing follows the books, and even then if they do it’s questionable in the world of Neonatology. I felt incompetent in many regards and nervous to be judged as a new presence on the unit. So when faced with this new challenge, I did what I’d practiced time and time again doing locum tenens, I swallowed all my fears, took a deep breath and plunged into a new adaptation running the scenarios I’d done in my head time and time again, in real life.

Being in small hospitals gave me the skills I needed to become a strong leader. I confidently and calmly called for epinephrine, guided chest compressions, turned to the pharmacist to draw up amiodarone as our heart rate shifted to a lethal arrhythmia. I didn’t know the next step, but I tried as hard as I could to command the room, seeking out the collective experience of my team, asking for thoughts going forward. I listened, I stepped back, I took in the whole picture. When a voice was needed, I lent mine, strong among feelings of confusion and loss. I cautiously repeated the words my mentors had said as I focused on clear and closed communication, “At the next pulse check, if anyone can think of anything else we can do, please speak up… It’s time to get the defibrillator ready to delivery a shock… Continue chest compressions, 1 and 2 and 3 and…”

Weeks later, I was discussing the case with one of the older nurses that I hadn’t even realized was in the room… “There was chaos, and I heard your voice, and I heard a Leader.” Wow, my heart sank, me? A leader? Hearing this from such experienced humans I look up to so much shook every ounce of my soul as I waded through my feelings on whether or not returning to training for 3 more long years was a good idea. I was proud and more nervous to do a good job after hearing their confidence in me echo across the empty night halls. But, I have reflected on this night over and over again, and since it has happened again. Each time is different but each time I draw from the lessons I’ve pulled with me from locums. The strength needed to guide a team, the direction and the clarity to keep calm and control chaos, to adapt on the fly when the answer isn’t clear and to seek out the strengths of those around me that might know more than I do or see more than I can from my vantage point. I remember when my charge nurse Debbie D pushed me out of the way at a resuscitation in Maine and said, “Trevor, I’ve got the airway, I need you to be big picture.” I remember the times struggling to figure out my flow of direction as I built my confidence slowly over the course of those traveling years. If i had not done locum tenens, there is no way I would have stood up that night… Without doing locum tenens, I know my old self would have been quiet and unsure beyond belief… I’m still unsure, but I’m more confident about it.

We were successful at regaining a heart rate that night, if only temporarily before it slipped away into silence; but, the bonds that team formed are some that I will cherish forever.

To some of the smartest and most compassionate nurses I’ve ever worked with, Thank You for allowing me to be part of this team.

RIP

Image Credit: https://acls.com/articles/what-is-pulseless-electrical-activity-pea/