Why is a raven like a writing desk? Musings of an orthopod

"So they want to get to know me, do they?" *sneers* - Jim Carrey as 'The Grinch'.

Hello, royal cabinet. This expert article is brought to you by the above title referenced juxtaposition from Alice in Wonderland. Lewis Carroll reportedly did not ever expect for there to be an answer, but this question has plagued me for years. It is about the very concept of what it feels like to be told, even by oneself, "you're the expert. What do we do?" 

Girl, I don't know.

*Proceeds to explain exactly what to do*. 

A colleague of mine recently enlightened me with the phrase, "expert enthusiast". He defined it as being both incredibly well-versed and familiar in a topic while also finding joy in teaching it and sharing it with others. I suppose you could call me an expert enthusiast about many things, if that is true. Creme brûlée, for starters.

In reading this, however, do not dare presume that by comparison you are not also an expert enthusiast or somehow incapable of understanding the inner machinations of my mind (an enigma: *queue spilled milk carton clip as a thought bubble just above my head*). You must only consume literature, knowledge, education, and experiences in the exact duration and way I have to understand the studies for which I am perceived as being an expert.

 To prepare you for your future as "the expert" on [insert specialty here], healthcare or otherwise, you may find yourself feeling fraudulent in even hearing this description: the expert. This lingering sense of self-doubt, groundlessness, and imposter syndrome will cloud your soul. It will weigh heavy as the crown atop your sweet, weary little head, until it does not.

I wish I could give you a timetable for when that weight is lifted. I can most assuredly give you the peace of mind in saying that you will become the expert, in time. You may find yourself, quicker than expected, reveling in your most challenging patient encounters, about what you could do with that knowledge in teaching or sharing it with others. You may notice the internal flickering of a lightbulb on the way home from work, or in my case after saying something to a colleague while deliberating on a plan of care or patient disposition,

"Did I just say verbatim what that brilliant, dually trained critical care/emergency medicine attending surgeon taught me like 4 years ago during that awful night where I cried in the bathroom an hour into my shift? How did I even remember that? When did I become the teacher???" 

You will find, in time, unique patterns in your own ways of thinking. You will find comfort in your experience, and you will continue to build on your experiences. In practicing medicine, this is known as the evidenced-based approach to clinical decision making. We utilize what is tried and true and build our own castle of applause-worthy patient care encounters in the interim. We use evidence-based approaches until we are the evidence-based approachers to your care. I think that is where the "medicine is an art, not a science" comes to life, and gives us all a second to take a breath.

There will be no golden AI algorithm, textbook, or scholarly article, when it comes to caring for people, that can outdo a human healthcare provider. Regardless of scrutiny, regardless of board exam questions, full waiting rooms, etc etc., we as your providers must only defend one thing:

"I did what I thought was best for the patient". 

I have found in my 29 short years on this earth that one can reason themselves both into and out of every single decision, medicine as an art/science notwithstanding. I claim only to be an expert at being an enthusiast, rather than an expert at all. I love orthopaedic surgery in the way I have experienced it: orthopaedic residents from all over the world, in the very halls from whence I came (yes, I was born in the same hospital I worked at), hand injuries, spinal cord injuries, high speed collision trauma alerts, laceration repairs, post-operative infections, cards I have received from patients who thanked me for my time, and in the good outcomes outweighing the bad.

I am but a humble servant of a greater cause, to minimize suffering in this life however I can. Life is so worthy of joy, wellness, peace, and gratitude. Orthopaedics, emergency medicine, pharmacology, medical decision making, teaching, and congeniality are all my means to an end in achieving the goal of minimizing the pain that cannot be prevented for you. 

In every clinical encounter, challenging case, tragedy, trauma alert, and level 1 to the OR, I still remain in awe of the strength not of myself, but of you. Humans are capable of experiencing the most terrifying, perilous, fear-inducing events, and nevertheless persist. You are the expert.

I am grateful for this organization, its readers, and my patients, for connecting with me at a time when I and so many others in the healthcare workforce needed a light to follow in the darkness. I hope in reading this I can return that in kind. I'll leave you with this: 

"May it be a light to you in dark places, when all other lights go out."

- J.R.R. Tolkien. 

Love y'all, 

Storm 

p.s. it comes at night.