EM Mindset: Nikita Joshi – An Emergency Medicine State of Mind

Author: Nikita Joshi, MD (Clinical Instructor – Division of Emergency Medicine, Stanford University School of Medicine – @njoshi8) // Editors: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)

I was always drawn to Emergency Medicine, and not because of the television show ER. We see patients in their “natural” state of being, meaning that some come with premade diagnoses but with an acute change in something vital, but many more come with no prior diagnosis for their conditions. I love that Emergency Medicine means intervening at the exact moment in a patient’s life that is one of the most critical that they will ever have. And that seconds with the right action can lead to years of precious life for patients. Most of all, I relish that Emergency Medicine does not rely upon “requirements”. We do not have to have necessarily all of the right components to do a procedure, we don’t even have to be within the confines of a hospital to do what we do – save lives. We can practice emergency medicine in the wilderness, we can practice emergency medicine in the hospital cafeteria, we can even practice emergency medicine on the side of the highway. Because the specialty is not limited to a set of procedures or a set of diagnoses. Rather, the goal of a practitioner is to ultimately become the resuscitationist, and that transcends procedure, location, and equipment.

The EM mindset of a resuscitationist is a flexible mindset, and really the imagination is the only limitation. I think that is why the phrase “MacGyver it” is still a phrase, despite a new generation who never watched MacGyver.

This flexible mindset also means that an EM physician is always “on” and at work. I was driving down the highway on a beautiful May Sunday – Mother’s day. The traffic came to a screeching halt. I almost hit the car in front of me. As the traffic picked up almost immediately, I started to slowly pick up speed. I drove by a young woman holding her hands up to her bloody nose by the highway median next to a car that had crashed into the median with the engine still smoking. Immediately I noted that there was no ambulance and hardly any cars stopping. This accident must have just happened. I pulled over my car immediately and dialed 911, and while running over to the young girl, I noticed something else that made my stomach turn to ice. Right there, in the middle of the highway, with cars swerving around her, was another woman, laying face down, spread eagle. All this I very quickly and anxiously relayed to the operator. I ran to the young girl, I tried to question her as to what had happened, her answers were anxious and nonsensical, but still I could make out that her ABCs were intact.

I grabbed her hand and ran to the other woman, I tried to establish scene safety, but I also was more worried about the woman. There was a car right in front of her, protecting her in some way, with the driver and passenger still in the front seat. As I lifted my head, I looked around and noticed, that actually there were quite a few cars that had stopped and people were watching the scene, but not acting, observing. This irritated me, but I remembered that I am an emergency medicine physician, and my job is to act. Seconds are what matter right now.

If you are interested in reading the rest of this and other EM Mindset pieces, please see “An Emergency Medicine Mindset,” a collection evaluating the thought process of emergency physicians. This book is available as ebook and print on Amazon.