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    Slowing down: Veering from the modus operandi

    “The days are long, but the years are short” – Paul Kalanithi


    “Slow down, doctors!” a nurse yells after our team as we rush between patient rooms on morning rounds, trying to gather information and make decisions as quickly as possible before our 7:15 am hysterectomy. We continue to move at lightning speed, practically jogging to the ICU, gathering vital signs and ins-and-outs. Like a well-oiled machine, we bounce between rooms, the intern removing the Foley catheter while the junior resident puts in orders and the fellow listens for bowel sounds. Trainees are tasked with getting things done. Task. Check. Move on. We stop only briefly to divide up tasks for the morning, and then we scatter like passengers at a crowded train station, headed for different destinations.

    More: Managing dysmenorrhea

    Tick tock, tick tock. Time moves slowly as we watch a prolonged deceleration on the fetal heart rate monitor. Every second feels like a minute, each minute like an hour. Yet as time lingers, our minds race—Does she need an emergent cesarean? Can we watch this baby a few minutes longer before moving to the operating room? Does the patient know what’s happening? Time is the entity that defines our productivity as physicians, dictates our efficiency in a given day, and judges our ability to make decisions when it matters. The paradox of time lies in the discrepancy between the actual passage of time and the way in which we experience this time.

    Tick tock, tick tock. A patient with a suspected ectopic pregnancy becomes acutely hypotensive, tachycardic, and clammy to touch. Every minute matters, as a ruptured ectopic pregnancy can lead to life-threatening hemorrhage if not managed expeditiously. We call in an anesthesiology team, consent the patient, forewarn the blood bank, and rush her to the operating room, all within a matter of minutes. Time moves quickly. We feign calmness while our adrenaline levels soar. As the patient bleeds more briskly, we work at breakneck speed in complete synchrony. When we finally tie off the ruptured pedicle, we catch our breath. The finesse of managing a surgical emergency comes with experience, and in our training, we all prepare ourselves for moments like this when we must act quickly and decisively.

    NEXT: What are the important questions to ask?

    Yalda Afshar, MD, PhD
    Dr. Afshar is a Maternal-Fetal Medicine Fellow in the Department of Obstetrics and Gynecology, University of California, Los Angeles


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