Volume 33

March - 2022

Cover: AHOY!

I had an incredible time capturing the wonderfully bizarre "Pirate Tower" in Laguna Beach. After spending the better part of an hour dodging Insta models, I was so excited to capture the motion of the water just right against the rocks.

Letter from the Editors:

Welcome to Art of Emergency Medicine, an online blog featuring amazing works of art created by your Emergency Medicine colleagues, along with their own stories of wellness and inspiration. Each month we try to focus on a new topic within wellness, and this month we’re talking about develop team dynamics.

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Working in Emergency Medicine is no longer a solo act. From the prehospital care teams of paramedics and EMTs working together, to interhospital dynamics between doctors, nurses, social work, and others, the delivery of high quality patient care hinges on the collaborative effort of all these different people. Developing and enhancing a strong team dynamic is crucial to improving patient outcomes, improving efficiency, and enhancing your own wellbeing. 

Multiple studies have demonstrated that poorly functioning teams can lead to increased rates of burnout for the individual members, emotional distress, depression, and increased amount of clinical errors. On the other hand, other studies describe the benefits of enhanced team dynamic including improved patient outcomes, provider satisfaction, and investment within work. 

It is important to know what goal you are striving toward. A strong and well performing team has several aspects:

• Communicative - The single most important aspect in team dynamic is communication between all members and trust that all information is shared. 

• Shared goals, Individual roles - The realization that each member has a clearly defined role that attributes as whole to the common goal. 

• Collectively Smart - Able to understand their teammates’ subtle social cues and identify emotional/physical stress that may interfere with group dynamics and be willing to intervene. 

• Subvert the Common Knowledge Effect - Do not solely focus on the information that is widely known in the group, but instead make open conversation to information that is unique.

• Honest and Humble - Transparent about mistakes and humble enough to ask for help when needed. Willing to rely on any of the other teammates. 

• Curious and Creative - Willing to reflect as a team on past mistakes, excited to develop improvements, encourage personal and team professional development.

However, developing a well functioning team is not easy. Due to constantly changing staff and roles of individuals in the department, the implementation of perceived hierarchies, and mistakes, trust may not be readily provided by individuals within a hospital or EMS system. Beyond this, each system has its own culture that shapes interactions, changes dynamics, and raises or lowers the level of inclusiveness. 

So, what are simple actionable items you can start doing to improve team dynamics at your workplace?

• Learn everyone’s name and say hello.

  • Small actions accumulate to have large effects, both positive and negative. Focus on creating positive interactions. 

• Practice closed loop communication and confirm everything, even when obvious

  • Minimize errors in communications and realize that knowledge that may seem obvious to you, is not necessarily clear to all members

• Clarify roles and delegate tasks

  • Ensure that each member of the team knows their roles, and if specific tasks need to be completed, assign them to specific members. Goals that are delegated to the room may not be completed. 

• Ask Questions

  • Be curious, allow others to be curious. Knowledge and communication is how teams learn to grow and trust. 

• Do what is right for the patient

  • When experiencing conflict or disagreement, ultimately, refocus the team towards choosing the best course of action that will benefit the patient.

Ultimately, it’s about creating an environment where the people you work with provide you support with second thought. It's about trusting your team to intervene when you operate outside of the norm. It’s about developing a family and community. 

Be Rad

This is a portrait of my dog, Brady, who also goes by the names Brade, Brad, Bradley, and Be-Rad.

Peace While Dyspneic

There is something mystical that happens, sometimes, in the middle of a busy shift in a moment of connection. Placing my stethoscope on her chest with one hand while the other hand sits reassuringly on her shoulder, feeling the beat of her heart and the rush of her breath in my ears. She’s old, frail, hard of hearing and sweet. Wearing a chain of gold on her neck, gilded like a queen, she sparkles quietly in the white sheeted hospital bed. Somehow, through my PPE and my walls she pulls emotion from me – not knowing, she can’t sense the relief I feel. Relief, that I can still connect, still find meaning in the smallest of examination details in the Emergency Department. Through it all, through the Covid pandemic and my own shortness of breath, I find peace. For a moment.

I start my shift in the locker room, as I always do, saying hello and goodbye to the nurses coming and going, fresh and stressed, eyes sparkling or hooded. Tonight one sits quietly on the bench holding the small of her back, tired, defeated, she gets up to leave me space as I beg her to stay. Next, I look up at a colleague with sad eyes, as we ask each other, “how are you?”. Masked, I can’t see the up or downturn of her mouth, but she says “so so” with a gesture of her hand and turns away. Stopping, I think how to ask, should I ask, and the locker room empty save for us I gather strength to say “what’s wrong?”. Suddenly the tears burst into her eyes and I can see the relief; she opens the gates and tells me. Somehow, through my difficulty breathing and with my hoarse poorly perceptible voice I give and take with her until she feels supported, heard and with a plan. Thanking me she leaves, to meet me shortly in our unit, both of us soon to be masked and shielded against what’s to come. Pulling my walls up tight again I take my deep calming strained breaths and remind myself, through a haze of my own tears, that this is what I come to work for. To help those in need, to heal, to offer any strength I can at any moment that I can.

Caring for the wellbeing of my colleagues is just as important, now, as the care of our patients. Without imparting strength to each other, and holding our friends up when they are weak, we can’t continue to face the tsunami of pain each shift. So, breathless, we give to each other when we can hardly give to ourselves, and find peace, even just for a moment.

This piece was inspired by true moments on shift during the covid pandemic. As an Emergency Physician it can become easy to disconnect from patients as humans, and I find re-connection through my writing. Sometimes I find myself sitting on the toilet during a busy shift, taking five minutes to jot down my feelings around a particularly riveting conversation or interaction. Putting "pen to paper" or fingers to keyboard or screen lifts some of the heaviness I feel inside, and allows me to breathe easier. Writing is my outlet towards wellness.

What do you thinK?

I was taking a walk at Black's beach at San Diego on a casual afternoon trying to capture the beautiful SoCal sunset. Then I walked past this pair of surfers talking to each other facing the ocean. The sun is setting but the waves are getting higher. I was not close enough to hear their conversation. However, I think they are debating if they want to call it a day or catch another ride.

Whale Rock

Fresh air, bright sun, wind in my hair. All seem so counterintuitive to my daily routine within hospital walls with fluorescent lighting, air conditioned rooms, and filtered air. It provides an excellent foil and regenerates my energy getting ready to face another day and shift within the ED.

Do you want to see your art shared with the community? Don’t forget to submit today!

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This Months Featured Artists:

Andrew Thorne, MD

I am an emergency medicine resident at Harbor-UCLA with a passion for wilderness medicine. I began pursuing photography in medical school as yet another way to engage with the outdoors and share the beauty I find with others.

Louie Wang

My name is Louie and I am a first year medical student at David Geffen School of Medicine at UCLA. I received my camera as my birthday gift in 2013 and have been shooting nature/landscape photograph ever since. I enjoy traveling, camping, hiking, and explore food scenes.

Haedan Eagar

I am a third year medical student with a lifelong dream of practicing EM. I starting painting during medical school as my mind often needed a break from thinking about science. My favorite thing is that art has no “rules” to follow. I have recently begun quilting and look forward to making my own patterns.

Sara Ahronheim, MD

I am an Emergency Physician practicing at the Jewish General Hospital in Montreal, Canada. My passions lie in Physician Wellbeing, and in creative writing. I have been writing since elementary school, and have really developed my voice since 2002 when I began sending out an "email journal" (now known as a blog...) about my experiences as an ambulance medic in Israel and subsequently as a medical student, resident and attending physician. I blog at myblackscrubs.com and moderate the Canadian Women in Medicine blog at canadianwim.ca. I am preparing a book for publication in between crazy shifts and being a busy mother to two young kids and a feisty pup.

Jonathan Warren, MD

A PGY-2 at Harbor-UCLA Medical Center and founder of Art of Emergency Medicine. His hobbies include photography, hiking, Netflix, and dogs. He’s always on the lookout for the next adventure. Find more of his photography on Instagram.

You can learn more about the artists featured in this and other volumes at our contributors page!