Thursday, September 04, 2008

Me, In A Page

Lately, I've been diverting most of my wordsmithing to a one page document that may be the single determinant of where I spend the next four years of my life. Putting these ideas about science, medicine and society into a page has me really excited about a career in emergency medicine.


One late summer night in Harborview Medical Center's emergency department, an exasperated medicine resident turned to me with a rhetorical question: “Who would want to treat homeless, drug-using prostitutes?” When I immediately thought, “I do,” I knew I was home. This epiphany at the end of a month in Seattle’s level one trauma center cemented my commitment to a career in emergency medicine. Contributing to the trauma team, working with a diversity of cases, the rapid progression from presentation to diagnosis to treatment, and the societal issues I pondered after each shift all conspired to entrench my connection to the ED.

My path to a career caring for the acutely ill started with dreams of building life support machines. As a clinical technician for the University of Pittsburgh's artificial heart program, I learned that invention and patient care have a tendency to interdigitate. The image of science and medicine clasping hands framed my motivation for earning a bioengineering PhD. I developed innovative new surgical, molecular and tissue engineering techniques as part of my thesis project to improve the viability of embryonic stem cell-derived cardiac tissue replacements for use after myocardial infarction. Long hours in the lab doing thoracotomies on mice and measuring with echocardiography the extent to which we were repairing infarctions introduced me to the importance of intellectual and manual dexterity in medicine. Experience suturing hundreds of rodents enabled me to consider each human laceration repair a new artistic challenge. My first successful ultrasound-guided basilic vein cannulation opened wide my appreciation for sonography in the ED. Emergency medicine requires mastery of numerous techniques and knowledge from many disciplines; this environment of collaborative innovation makes EM a perfect career for someone like me who wants to combine multiple skills and interests to provide the best care for patients.

The notion that today’s scholars have to focus narrowly on subdivided fields in order to make contributions to society contrasts with my perspective that the actors of social change must think deeply in multiple fields. As a graduate student working with human embryonic stem cells, I learned firsthand not only how scientific research occurs in the context of social and political concerns, but also that scientists and physicians are obligated to contribute to public dialogue. I am as proud of defining 'blastocyst' and 'in vitro fertilization' for stem cell research legislation in Washington State as I am of my labwork to further the potential of cardiac regeneration. Through a science policy group I co-founded, I planned campus-wide conversations about genetically modified food that spurred constructive conversations that continue more than three years later. Hosting President Clinton's science advisor to engage the University of Washington about the future of research funding in America offered a glimpse into the importance of sound science policy.

However, one needs look no further than county hospitals' waiting rooms to see that innovation in patient care is not merely a scientific enterprise – it needs to be a social one. Our current policy morass of underserved health care in America establishes emergency medicine as the front line for individuals seeking to heal people and the system. Solutions are not easy to find, especially from within the academic ivory tower; some of my understanding of the complexities of urban health care is grounded in relationships I've built over four years as an STD counselor for homeless teens. I aspire to be the emergency physician who draws on experience treating the neediest of patients to facilitate difficult conversations about health policy.

The ED is not merely a safety net. Challenging ethical dilemmas that emerge from a diversity of diseases, the urgent presentation of humanity in crisis, and the varied manner in which people respond to acute illness demand that emergency providers have ethical reasoning skills at the ready. The emergency room is a laboratory for teaching medical ethics; I hope to translate an “Ethics in the ER” course I developed for medical students at the University of Washington into a training tool for tomorrow's doctors. My experience designing this course has helped me understand better that educating others is a critical element of the practice of medicine. Teaching forces me to shore up topical understanding and requires communication accessible to a range of individuals: patients, students and colleagues. I look forward to an EM residency that provides both teaching role models and opportunities to refine my own skills.

Scientist, activist, writer, ethicist, engineer, doctor: for me, each of these roles supports the others. Rather than a collection of titles in separate contexts, I prefer the simple title of citizen-physician. There is deep meaning in the patient-physician interaction, both in the literal space of a sick person seeking care and as a metaphor for how physicians can improve society. My diverse and well-developed interests are ingredients for a career in emergency medicine that steps beyond discrete disciplines to address patients’ immediate health needs and improve the practice of medicine.

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