It is difficult for new members to join an established tightly-knit team that has shared intense, life-altering, emotionally charged experiences with each other for many years.
Lifelong Learning in Clinical Excellence | April 11, 2019 | 2 min read
By Ivor Berkowitz, MBBCh, MBA, Johns Hopkins Medicine
Not long ago, in his evaluation of his Pediatric Intensive Care Unit (PICU) rotation, a junior resident said that he did not feel like a full member of the intensive care team. I was concerned. I wondered whether we needed a broader, more thorough orientation program, a better introduction to the other physicians, nursing staff, respiratory therapists, pharmacists, and social workers, or more or different team meetings.
I had an epiphany after watching a rerun of the TV miniseries, “Band of Brothers,” based on the book of the same title by the late Stephen Ambrose. The series follows the story of Easy Company, 506th regiment, 101st Airborne, through their grinding boot camp training, the D-day invasion of Normandy, and the battles beyond. Team training, harsh conditions, combat, and death created a close-knit unit, a supportive group of soldiers who were willing to die for each other – a band of brothers.
I have never served in the military, but it strikes me that working in the PICU resembles combat. We take care of the most critically ill, injured, and dying children. We use military metaphors. Our fellows attend “PICU bootcamp.” We work in the “trenches.” Critically ill children are “fighters.” Parents declare “we will beat this!” when referring to their child’s illness. As a team we attack problems presented to us, planning for victory, and yet understanding we might experience defeat. We are surrounded by blood, death, grief, sadness, and broken hearts, but victories are plentiful as well, and when they come we share in the joy of remarkable recoveries and healing.
Our PICU team, many members of which have known each other for many years, know how each other will react, respond, and perform in challenging situations. We function together like a well-drilled platoon, helping each other to save the lives of desperately ill children. True battle victories! We know each other, our skills, limitations, and idiosyncrasies. We have an unspoken instinctive understanding as to how our colleagues will respond in desperate situations. We all suffer when a child is lost, and we support and understand how such losses hurt our colleagues. We worry about each other, when the children of our colleagues are ill or their elderly parents are hospitalized. We celebrate the weddings and the birth of children and grandchildren of our team members.
We are a band of sisters and brothers!
We are, all of us in the PICU, confronted with high drama that is emotionally wrenching. It is always difficult for new members to join an established tightly-knit team that has shared intense, life-altering, emotionally charged experiences with each other for years. I love and respect my brothers and sisters. I appreciate our shared effort, hard work, and history beyond words. With this in mind, it is clear how difficult it must be for rotating residents to feel part of us.