Slowing down: Veering from the modus operandi

May 11, 2015

Contemporary OB/GYN's Resident blogger reflects on the way that time changes on the job from the rush of morning rounds to the agonizingly slow minutes while watching fetal heart rate tracings in prolonged decelerations.

“Slow down, doctors!” a nurse yells after our team as we rush between patient rooms on morning rounds, trying to gather information and make decisions as quickly as possible before our 7:15 am hysterectomy. We continue to move at lightning speed, practically jogging to the ICU, gathering vital signs and ins-and-outs. Like a well-oiled machine, we bounce between rooms, the intern removing the Foley catheter while the junior resident puts in orders and the fellow listens for bowel sounds. Trainees are tasked with getting things done. Task. Check. Move on. We stop only briefly to divide up tasks for the morning, and then we scatter like passengers at a crowded train station, headed for different destinations.

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Tick tock, tick tock. Time moves slowly as we watch a prolonged deceleration on the fetal heart rate monitor. Every second feels like a minute, each minute like an hour. Yet as time lingers, our minds race-Does she need an emergent cesarean? Can we watch this baby a few minutes longer before moving to the operating room? Does the patient know what’s happening? Time is the entity that defines our productivity as physicians, dictates our efficiency in a given day, and judges our ability to make decisions when it matters. The paradox of time lies in the discrepancy between the actual passage of time and the way in which we experience this time.

Tick tock, tick tock. A patient with a suspected ectopic pregnancy becomes acutely hypotensive, tachycardic, and clammy to touch. Every minute matters, as a ruptured ectopic pregnancy can lead to life-threatening hemorrhage if not managed expeditiously. We call in an anesthesiology team, consent the patient, forewarn the blood bank, and rush her to the operating room, all within a matter of minutes. Time moves quickly. We feign calmness while our adrenaline levels soar. As the patient bleeds more briskly, we work at breakneck speed in complete synchrony. When we finally tie off the ruptured pedicle, we catch our breath. The finesse of managing a surgical emergency comes with experience, and in our training, we all prepare ourselves for moments like this when we must act quickly and decisively.

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Tick tock, tick tock. Time slows down as our decompensating cancer patient becomes progressively sicker on the floor. Daily rounds and conversations with the patient’s family require time and patience. We dedicate ourselves to sitting at the patient’s bedside, providing careful guidance, and discussing goals of care. The years of this patient’s life have profoundly left their mark on her loved ones; this is not a brief conversation. We must slow down to think of the right words, or at least the right sentiment, to convey to this patient and her family. This is not a surgical emergency. Speed is not the appropriate measure of aptitude.

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Knowing when to slow down and when to speed up is something that, ironically, takes time. Anyone in medicine will tell you that our training is a marathon, not a sprint. “Deemphasize velocity. Life is too fast,” said the legendary gynecologic oncologist Dr. Leo Lagasse. As medical students, we spent hours gathering information on patients and practicing our presentations. As residents and fellows, we do not have this luxury. Yet, we tend to forget the days of our past. We sometimes become impatient while listening to the medical students’ wordy assessments on rounds. We shouldn’t consider this slowing things down, but rather, reminders of our journey from fellow travelers now at earlier stops along the same path.

During our medical training, the art of changing pace can be especially difficult when we leave the hospital. How do we walk away from our fast-paced days at work and shift our thoughts to our loved ones, our responsibilities outside of the hospital, and even ourselves? How do we bring our high-speed trains to a screeching halt?

In a broader sense, how do we make the most of our years of training and move away from a means-to-an-end mentality? Before we know it, our training comes to an end, and we are faced with the reality of the medical careers we have chosen. Will they be everything we had waited and hoped for? Perhaps only time will tell. Or perhaps we should take a moment of introspection and remind ourselves why we chose this profession in the first place. We must learn to enjoy the journey. Slow down, doctors. 

Dr. Zakhour is a second-year gynecologic oncology fellow at UC Los Angeles / Cedars-Sinai Medical Center. Dr. Afshar is a third-year resident in the Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center in Los Angeles, CA.