I Am Enough with Grant Smith, MD
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What does the episode’s introduction reveal about the focus on medical rites of passage?
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When becoming a doctor, there's a lot of rites of passage. dissecting a cadaver in anatomy lab, the first time you break bad news to a patient. But the one that takes the cake, the one regarded with the most dread, is being code leader. I'm Emily Silverman, and this is The Nocturnists, stories about what it's like to work in medicine. In this episode, we talk with Grant Smith, chief resident in internal medicine at UCSF, who plans to go into palliative care. Grant walks us through his first experience as code leader. And afterward, we talk about the anatomy of a code and different ways of dying in the hospital. I give you Grant Smith.
Hi. So for me, one of the hardest things about being a resident is that we often have to do a lot of things for the first time. And I know that a lot of people our age are doing things for the first time in their jobs, and doing things for the first time is a part of any new job. But I always felt like our first time things are often, why am I doing this, and what am I doing? I think some of the things that come to mind is, you know, oh, hey, do you want to stick a needle in this person's back? Yeah, yeah, it's going to go right by the spinal cord, but it's no big deal. We're just going to get a little fluid out. Like, that is crazy. Other things that come to mind, the first time you have to sit down and tell someone, I'm really sorry.
I'm really worried that you only have days or weeks left to live. This is crazy stuff. Like, this is not normal. My biggest reflection on this is when I tell these stories to my brother, who's not in medicine, and he is always like, wait, they let you do what? Please never take me to a teaching hospital. I never want to go there. It sounds terrible. I think like a lot of residents, one of those firsts that I was most nervous about was having to lead a code. And most of you in the audience know that a code is when a patient's heart stops, they start breathing, or they just look so terrible that people think that they're going to die. And they announce these things overhead on the intercom over the hospital.
A whole team of people run. And as the code leader, it is your job to run this show. So it can be very intimidating. So as I was thinking about the first time I had to run a code, it was when I would be at the VA on wards. And most days of the week, not the second year resident running the code. It's normally someone from the ICU team. But on Thursdays, those people just aren't there. So it's your job. That's fine, whatever. So in my mind as I'm getting ready for this, I know this is coming, it starts creeping into my head at random times. So I remember one time I was out running at Land's End, and I was overlooking the Golden Gate Bridge and the ocean, and I was imagining going up and being like, my name is Grant Smith, I'm the co-leader, and just fantasize, and I was just gonna boss this so hard.
But fast forward to the night before starting VA. I've got my code cards. I've got my code script. I'm going over it in my mind. And I'm feeling like, OK, I kind of know what I'm going to do. But there still is this pit in your stomach that is like, oh my gosh, do I know enough? Am I going to be able to act fast enough? And am I enough to do this job? So second night on call, it's 2 AM, and overhead, Code blue, I see you. Code blue, I see you. I don't know why the voice is trying to be so calm. It's terrible. And at that moment, I was like, this is like being on a flight and having the oxygen mask come down. It's like, you know it could happen. You kind of remember what the lady told you to do with it. But you're still like, oh, fuck.
So, okay, the sirens are going off, my pager's going off, I get up, put on my white coat, I've got my code cards in, I've got my pocket in, I've got everything that I need, and I start running, you know, trying to do the stethoscope, hold, card, thing, hold, I'm running, I'm running, okay, okay, okay, we're gonna do the code.
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