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Playing Ahead of The Game

by Lucky Garvin

I am privileged to work with a group of highly motivated and very bright medical practitioners. But as capable as they all are, not one of them would deny that the ER shift which causes them the greatest apprehension is midnights  [graveyard]; specifically the hours between 3-7 AM.

Something heavy and gray lingers in the back of your mind. You might deny it, but it cares not at all whether you poo-poo or acknowledge it; it’s there. During these hours you are alone. One physician, forty treatment areas – and yes, a great nursing and tech staff – but the final decisions are yours.

Unlike any other specialty in medicine, in Emergency Medicine any medical condition you can name or imagine might come screaming in the door from a new-born in cardiac arrest to some obscure medical disorder which has rapidly deteriorated. Often these medical presentations have no past medical history, no patient information… you’re going in totally cold.

The ER doc is supposed to be ready for anything; and, frankly, that’s a lot to ask. In those hours, you have no partner to turn to for a second opinion. So, to the degree you are able, how do you prepare? You study. By the time the emergency arrives, it’s too late to grab your computer or your text books. You prepare; “Pre” = “Before.” It was shortly after such a shift – one that bought with it a few clinical surprises which, happily, I managed with an uncharacteristic efficiency – I remembered Harry.

I used to play Little League baseball, due in no small part to Harry Hicks. Harry was a short, peppery, middle-aged guy with a poorly-trimmed brown mustache, a balding head, calloused hands, and a love of baseball and kids. Oh, one other thing: his attitude. Had Harry been born a machine, he would have been a bulldozer. His firm, Hicks Lumber sponsored our team.

There are two things Harry did each game: bring a small cardboard container of Wrigley’s chewing gum – individually wrapped – which he would dispense to us. We covered our bases or sat in the dug-out chewing and feeling ever-so big league. The other thing he did was to peer out over his black-framed glasses and roar at us covering our bases, the batter striding to the plate, “WHAT ARE YOU GOING TO DO IF THE BALL COMES TO YOU?” [Bulldozer.]

In other words, figure it out now, because if the hit is right at you, grounder or fly-ball, Harry felt it was probably a bit late then to size up the tactical situation. I heard this hollered question time and time again. Interesting, it had its effect on us even if we were the runners on base: what are you going to do if the next hit is a high-pop fly? An in-field grounder? An arching ball to center field? Tag-up, or not? Figure it out now, because when it happens, there’ll be NO TIME.

It came to me, my shift finally over, the sun slowly waking over our beautiful valley’s mountains:  for most of my adult life, I had – without realizing it – taken Harry’s words to heart without ever crediting him with such wisdom.

I have made provision before the need arose. I have smoke detectors, fire extinguishers, and property insurance, although I’ve never had a fire. I protect my home with two burglary systems – one canine; one electric – health insurance, saving money… well, you get the point. Most prudent people try to anticipate trouble by asking themselves – in Harry’s words– what if the ‘ball’ comes to me or my family? And that is why we in the ER study our craft.

Harry wanted us to play ahead of the game. Although, as a boy, I didn’t recognize his wisdom, now, as a man grown, I most certainly do. Thanks, Harry. We owe ya.

Look for Lucky’s books locally and on-line: The Oath of Hippocrates; The Cotillian; A Journey Long Delayed.

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