Emergency Ultrasound: Ultrasound as My Antidote

“As our health care system devolves into more of a business, here was a place where the idea of medicine as a service, and physicians as servant-leaders, still exists.”

Ultrasound as My Antidote

Neha Bhatnagar, MD

II know I am far from the only emergency physician feeling the weight of this past year. I have read and heard numerous stories about the collective trauma, grief, and tragedy we have all faced in this trying time. I have my own such stories I could share. But instead, I hope to share with you a few anecdotes based on real encounters that I have tried consciously to carry with me as glimmers of hope. What follows are a few examples of how I have tried to combat the moral injury I have absorbed using the facet of my career that I am most nerdy about: Ultrasound. I know, I know, I drank the Kool-AidTM. But bear with me, these stories are not really about ultrasound. They are about people. I moved to the big city for my ultrasound fellowship in June 2020. I am grateful for so much of what I have experienced here, but moving across the country, away from my support systems, during a global pandemic has raised its fair share of challenges. For months I worked, learned, fumbled, adapted, and worked some more. I barely unpacked or settled in, I barely explored my new home due to shutdowns and quarantines, and I barely socialized with my new coworkers and friends for fear of contracting this invisible, unpredictable deadly disease. When the pandemic restrictions began to lift in the spring after mass vaccination efforts, I began to seek out other avenues to do good. I began to volunteer at a local free clinic serving the city’s Spanishspeaking population. I am no primary care physician, but having the opportunity to discuss whole-body health issues with vulnerable patients made all the difference. Once I mentioned my ultrasound training, they eagerly asked me to evaluate a few patients using my handheld device. In doing so, I helped expedite referral to surgery for two patients who needed biopsy or excision of their concerning soft tissue masses. In this space, no one cared about my metrics, no one was counting how many patients per hour I was seeing, no one was asking me to stop counseling a patient or discharge them more quickly in order to get the next patient into that room. As our health care system devolves into more of a business, here was a place where the idea of medicine as a service, and physicians as servant-leaders, still exists. There I can be the generous, attentive, thorough doctor I want to be. And it makes me smile. While on one of my weekend night shifts, I had an elderly woman present with abdominal pain and bloating. Her workup quickly revealed a perforated bowel. As I discussed her results and the surgeon’s recommendations, she acknowledged the gravity of the situation, and voiced her wishes for comfort measures only. Once her symptoms were controlled, I tenderly asked if she would allow me to obtain a few educational ultrasound images of her pneumoperitoneum. Her smile widened as she consented and warned me that the longer I stayed in the room with her, the more she would tell me about her children. I said I would love to hear all about them. She chatted and I scanned, and for a few minutes that was all there was. When my exam was complete, I helped her get situated in her bed, and she asked that I push her blanket in further, proclaiming, “You’re only ever as cold as your feet!” I laughed, told her how true that was, and tucked her feet snugly under the blanket. I thanked her for letting me perform the scan and wished her goodnight. Two days later, I opened her chart to follow up and was met with the EMR’s alert asking if I was sure that I wanted to enter the chart of a deceased patient. Like hundreds of thousands of others this past year, she has passed on, but our connection has not. Now I think of her every time I tuck a patient’s feet under their blanket. And I smile. The biggest reason I chose to do an ultrasound fellowship in the first place was my love for teaching. While the pandemic has raged, there have been limitations on in-person ultrasound workshops, emergency department rotators, and of course national assemblies this past year. Like many other educators, I have endeavored to expand beyond the never-ending drone of video-conference lectures with games and more interactive content. I strive to teach as much as I can on-shift, but with only limited time to dedicate to learners while balancing my duties as a new attending in a busy urban academic ED, I have felt pulled in multiple directions. I have struggled with imposter syndrome at every turn, without being able to focus on what brought me to this job. However, the kind and unexpected words of one of my students this past year has helped me pull out of that dizzying array of responsibilities: “Dr. Bhatnagar is an exemplary teacher and clinician. Her ability to distill complex ideas into more manageable bits of information was not only helpful to learners like me, but also for her patients… Both compassionate and confident... Grace and empathy… It is rare to find preceptors so dedicated to your learning.” I do not share this student’s words as any sort of humble-brag. I share them because they are words that I have not been telling myself. They are words that I did not know I needed to hear. And I would dare assert that many other emergency physicians out there are similarly not seeing, appreciating, or valuing their own worth in this difficult time. My best

is not what it used to be, but it is enough. And when I revive my sense of purpose, it is everything.

When my dark days come back, as they have with every wave of this catastrophe, I re-read his words. And I cannot help but smile. In a world where close contact can kill, the power of touch while using bedside ultrasound has been a lifesaver for me: to touch an underserved community’s needs, to touch a dying mother’s feet, to touch a bright-eyed student’s heart. Ultrasound alone is not the cure for all the languishing I have been experiencing. Yet what it represents is: service, connection, and purpose. I hope you find yours too, and I wish you well.