Growing Doctor Wings: From Resident Physician to Attending

Growing Doctor Wings: Dr. Darilyn Moyer

“Tombstones? Do the EKG changes look like tombstones?” were the first questions I asked my 4th year medical student subintern when he called me.  I took a deep breath and tried to suppress the sick sensation in my abdomen when he answered, “Yes, I think so”.

The moment of truth had transpired with the initial literal and figural spreading of my immediate post-intern wings. I’m not sure how my newly minted PGY-2 vessel actually transported itself from the housestaff quarters at the community hospital  to the patient’s bedside but I  think a business card handcrafted paper wings that were awarded to me in a ritualistic process by my upper year residents at the end of my PGY-1 year had something to do with it!

The journey to the patient’s bedside  was effortlessly paralleled by the hypothesis testing racing through my mind… the patient had been transferred to the floor earlier in the day from the CCU where he was admitted for chest pain. My sub told me he was awake, alert and complaining of pressure-like substernal chest pain. He was diaphoretic but had stable vital signs. As I flew into the room, I found what I expected- a patient with the fear of death in his eyes. I had seen that look on other patient’s faces. The patient articulated every healthcare worker’s dreaded foreboding… “Doc, I think I’m going to die. Please help me!”.  In my short tenure as a medical student and a little over 1 year as a medical resident, I gained a profound respect for patient’s predictions of their demise.

Luckily, an experienced nurse was also in the room. After I checked the patient’s vital signs, quickly examined his neck veins, lungs,  heart  and looked at the ECG , the nurse not so telepathically pulled the sublingual nitroglycerin out of  her pocket as I asked for it.  Even though we may not have used the terminology of “healthcare team” in the mid-80’s, we all thanked our lucky stars for the experienced people around us who helped us learn to spread our wings so we could return the favor in the future.

As I picked up the phone and asked the operator to connect me to the CCU, I was overcome with feelings of command and confidence. As my imposter syndrome extricated itself from my brain. When the CCU nurse protested that she couldn’t accept the patient without getting report, I confidently told her “ the floor nurse will give you report now as I am on my way with the patient”. I handed the phone to the bedside nurse, unplugged the bed and asked my subintern to assist me in wheeling the bed to the CCU. Our wings flew us into the CCU just in time to get the patient into the only open room, get his chest leads on and watch as his rhythm transform quickly from sinus tachycardia to ventricular fibrillation. As my subintern looked on from a catatonic, plastered upon against the wall position, the code cart arrived and after 2 shocks,  sinus  rhythm was restored, the lidocaine given (yes, lidocaine- this was 1986!) and the CCU nurses and I worked to stabilize the patient and get him pain free.

By the time the other 2 medicine residents (one was my husband, also a PGY-2)  summoned by the overhead code call arrived at the scene, the patient was stable, in sinus and almost pain free. The PGY-3 resident immediately reviewed the situation with the nurses and I, assessed the patient, looked at the EKGs and commended us on our quick actions. My subintern was still looking a bit catatonic  but had developed a “what just happened” look. I walked over to him and  asked him to self-reflect on what just happened,  reviewed the scenario and articulated the clinical reasoning process that got us here.. another feather placed into his developing wings!


So how do we preserve the ability to allow our students, trainees and inexperienced attendings to develop and spread their wings of confident autonomy at a time when the pace of the contemporary healthcare environment accelerates, accompanied by increasingly complexity of patients and systems? By not forgetting to place feathers into their growing wings. It is vital that the  “wise owl frequent flyers” of the group take ownership of our important role stewarding the next generation of practitioners in medicine. We need to work with our institutions to find clinical and educational models that allow those with wings of confidence and clinical experience to assist our inexperienced flyers to the important stages of development of the clinical reasoning and synthesis process. They need those feathers to develop a set of wings that will soar!

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Dr. Darilyn Moyer is the Vice Chair and Internal Medicine Program Director, Department of Medicine, and Assistant Dean for Graduate Medical Education, Temple University School of Medicine and Temple University Hospital. She is a Professor of Medicine and Assistant Dean for Graduate Medical Education at Temple University School of Medicine.