EM Collective Wisdom: Lalena M. Yarris

Author: Lalena M. Yarris, MD, MCR (Professor, OHSU Department of Emergency Medicine; Co-Director, Emergency Medicine Education Section; Director, Emergency Medicine Residency Program; Co-Director, Education & Education Research Fellowships) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

I love Emergency Medicine more the longer I practice.  I still enjoy many of the aspects that led to my decision to pursue EM – the ability to care for all ages of patients from all walks of life, the pace, the continual challenge and opportunities for learning and growth.  However, what keeps me in clinical medicine now are the unlimited opportunities to connect with people in a meaningful way.  I find the greatest reward in working with learners, debriefing with my team after a difficult case, and in that sacred space that patient and physician share.  The ability to sit and be present with a patient or family member in their worst moments, to bear witness to the beauty and suffering of life, and the privilege of being told so many stories is what brings me meaning and purpose in Emergency Medicine.

2) Most impactful case. 

My most impactful case remains a tragic one.  Years ago, I was working New Year’s Eve in the pediatric ED, and had a child come in by ambulance after respiratory failure from reactive airway disease. The team worked hard, but was unable to resuscitate the child, and the outcome was heartbreaking.  However, it was a case where things flowed well – team communication was smooth, attention and care were given to the family, and the life of this child was truly honored.  After the code was called, efforts were made to make sure the family had enough time in the room with the child, and then staff worked to obtain handprints for the family to keep.  After the family left, the team processed our own sadness about the case together, and to this day we all remain close.  Even when we can’t change the outcome of our most difficult cases, our work in EM matters, and this case reinforced this lesson with me in so many ways.  It was also impactful in the way difficult cases can be paradoxically life- and love-affirming; in exposing the fragility of life our career can awaken our empathy and gratitude, and remind us that meaning comes not only from caring for our patients, but also for their families, our colleagues, and ourselves.

3) Most important career decision leading to satisfaction.

My decision to pursue an education fellowship after residency graduation was the most important decision I made.  It had a ripple effect, helping to pave a path for me in academic medicine that ultimately led to meaningful opportunities and professional relationships that have been the foundation of my career satisfaction.

4) What does future of EM look like?

Dynamic!  I think clinical Emergency Medicine will continue to evolve as our system continues to struggle to contain costs, use resources wisely, and care for patients in a way that aligns with their own values and prioritizes optimizing health over diagnosing and treating disease.  Our specialty has many leaders in patient advocacy, health care reform, and addressing biases that impact both patients and providers. We are disruptive innovators and risk-taking educators.  I anticipate EM having the potential to make a great impact on the future of the US health care and medical education, as well as medical science.

5) Greatest achievement / why giving back is important.

I’m proudest of the 2012 SAEM Consensus Conference on Education Research.  I was early in my career when I co-wrote the first draft of the proposal, and had the opportunity to co-chair the conference.  It was a huge collaborative effort of so many educators and researchers, and outside experts were supportive of our efforts and generous with their time.  It showed me how much we can accomplish when we work together, and I think the process and products of the working groups ignited an increase in education scholarship in our field.

6) Favorite failure.

I applied for a large research grant early in my career, and it was not funded. I invested a lot of work into it, and was discouraged and disheartened to not be successful.  But in retrospect, in my efforts to write a successful grant, I had morphed an idea I was excited about into a project that was more amenable to research, but less interesting to me.  If the grant had been successful, I may not have had time to pursue other opportunities that have been rewarding and influential on my career.

7) One thing you would change about our field.

Our field is uniquely demanding, and the stresses, culture of working a lot, and shift work really impact wellness. If I could, I would change the culture to institute systemic changes that support, rather than threaten wellness.

8) Something that you love that has indirectly impacted your EM career.

My love of endurance sports has impacted my career.  Training for long-distance triathlon and trail ultramarathons has provided a meditative outlet that has allowed me to maintain balance, and has also forced me to manage my time well and prioritize. I believe we have so much more control over our time and our experiences than we think we do, and I’ve learned a lot about both persistence and letting go during my long hours on the bike or on the trail.

3 people you’d like to see fill this out

1) Esther Choo

2) Michelle Lin

3) Jessica Smith