Luke didn’t need to help. His shift had ended an hour ago, and he’d stayed a little late to finish up before changing into his one suit in the attendings’ lounge. Still, the need to help with the accident outweighed the small part of him that pointed out that he should get going to the conference.
Luke raced after his colleague. In the first triage room, he scrubbed in and a nurse helped him into a plasticky green trauma gown. He hurried to the first patient, a man in his forties with a break in the tibia and fibula, as well as contusions to his forehead and chest.
“What’s your name, sir?” Luke asked as he pulled on gloves and grabbed the overhead portable x-ray to get a good look at the leg.
“Timothy Jones,” the man said. His voice was steady enough, but his eyes were very wide. Luke needed to assess him for shock.
“How are you feeling?”
“My leg hurts, but not so bad. How about the others? Are they okay? I was with my buddies in the car, Colin and Peter.”
Just then, Luke felt a hand on his arm. He looked up to see the last person he wanted to see — the chief of surgery.
“Mr. Jones,” Marco said, “Doctor Harris here will be taking care of you today. Luke, time to go. You’re needed elsewhere.”
Feeling more like a scolded child than a renowned surgeon, Luke followed Marco out of the trauma room. He pulled off his gloves and balled them up, annoyance surging.
“I figured I’d need to come get you,” Marco said, his tone between annoyed and amused. “This conference is important, Luke, and this isn’t your shift. Let your colleagues pick up a little of the slack.”
Luke tried not to scowl. Of course, he knew how competent his colleagues were — that wasn’t the issue. But every moment he wasn’t in the ER, he worried that something would happen and that he wouldn’t be able to do anything about it. It was a terrible feeling, and one he spent his life running away from. If he did everything himself, he didn’t have to worry about that.
Still, Marco was right. Luke had made a commitment to give the talk, and he would go — no matter how annoyed he was to be pulled away from an emergency case.
“I’m leaving,” he said, his tone betraying a little of how he felt.
“I know you don’t like doing this, but it really is important, for you and the hospital,” Marco said. Luke grumbled something, pulled off his trauma gown, and threw it into the hazardous-waste bin in the hallway before hurrying outside.
His car was waiting in the lot. He strode through the light rain to the car and got in. Before he pulled away, Luke had one last glance back at the hospital, wishing he could just go back in for five more minutes. Then, with a sigh, he drove, steadily and carefully as always, to the event.
Luke pulled into the hotel’s parking lot ten scant minutes before his talk was supposed to begin and glanced in the rearview mirror, rubbing at the crease on his forehead where his surgical cap had left a mark. With a sigh, he straightened his tie and got out. The event was being held in a large hotel with broad columns at the entrance. Luke hurried straight back to the conference room where he was supposed to talk, following signs and the smell of food. He quickly signed in at the desk by the door. As he did, he repeated his speech in his head.
He entered the main room just as the host for the evening began introducing him.
“Please welcome Doctor Luke Porter. Doctor Porter graduated summa cum laude from Harvard Medical School and completed his residency at the prestigious Mayo Institute. Five years ago, he moved to Portland and now heads the ER of Portland’s own Willamette Hospital. His triage techniques have helped reduce hospital wait times, streamline patient care during emergency situations, and reduce complications and mortality in the hospital at large. Today, Doctor Porter will speak about how to use some of these same techniques in your own hospitals. Please give him a big round of applause.”
There was applause, though Luke wasn’t sure it was a “big round.” That was reserved for the best. The doctors seemed distracted by the plates of appetizers currently being laid out on the tables by a team of white-shirted waitstaff.
Good. Luke had just finished a twenty-hour shift, and the last thing he wanted to do was talk to anyone — much lessin frontof anyone. The sooner this was over, the better. In fact, if he could be sitting at one of those tables and eating some of the delicious-smelling food instead of standing up here to talk, he would.
“Good evening, everyone,” Luke said, stepping up to the podium. His slides were already on the large screen behind him, which made it less of a problem that he’d forgotten his notes in the ER. “I’m here today to talk about triage techniques. I know many of you are family care practitioners, internists, or even dermatologists, who rarely, if ever, find yourselves in triage situations. However, the techniques I plan to share with you today will help you work more smoothly and efficiently — and prioritize better — no matter what you do.”
Luke glanced out over the sea of faces. Despite his catchy intro, no one seemed to be listening.Thatwas a huge part of the problem. He could help these doctors be better at their jobs and give better care to their patients, but they choose not to listen. They are too focused on their own egos to actually learn from anyone. Once again, Luke fought the feeling that no good could possibly come of this.
If even one person is listening and learns something, this will have been worth it,he reminded himself.If even one life is saved because of what I say here today, I won’t have wasted my time.
“Traditionally,” Luke continued, “triage relies on diagnosing patients quickly, based on limited information and even more limited history or interaction. This often leads to mistakes, with patients’ backgrounds being missed or internal injuries overlooked — or patients are simply thought of as non-emergency because they appear fine, even if that’s just because of a rush of endorphins after trauma.
“Therefore, these quick diagnoses often lead to more time wasted, as well as more patients put in danger down the line. That’s where my technique comes in.”
As Luke relayed how to use nurses and orderlies to create “glance sheets” — brief information relayed visually in a concise and consistent way — in order to allow doctors to make faster and better diagnoses, he saw more and more eyes glazing over. His hands balled into fists, but he managed to finish his talk and thanked everyone.
“Are there any questions?” he asked.
One doctor stood. “In my ER in Seattle, we treat nearly twice the volume of patients as you do, with record-low wait times,” he said. “Could this technique even apply to us?”
Luke stifled a sigh. As always, the questions were more about making the doctor asking look good than about actually learning something.
“Sure — even great ERs can always get better,” he said, then launched into a few things the doctor could consider. By the time Luke’s session finished and he was clapped off the stage, he was ready to completely shut down.
