By Dr Haney Mallemat.
Dr Haney Mallemat is an EM/IM Kings County/SUNY Downstate Graduate of the Class of 2008. He served as Chief Resident in his final year and subsequently pursued a critical care fellowship at Dartmouth. He is currently an associate professor at Cooper Medical Center in Camden, NJ where he focuses on critical care and ultrasound. Dr Mallemat also has an interest in education and has been recognized for his dedication with multiple teaching awards. Upon his return to his alma mater for the graduation of the Class of 2019, Dr Mallemat gave the following speech to impart his experiences and wisdom from his training.
(Editor-in-Chief’s note: This post is an opinion piece and does not necessarily reflect the views or objectives of County EM.)
Lesson #1: You Gotta Have Grit
….without grit you will never survive the County. What’s grit you ask? Grit is defined as fortitude, toughness, hardiness, resolve, determination, and resolution. County is insanely busy, but the work needs to get done, so I learned early on that you have to ditch the notion that “I’m the doctor”, and roll up your sleeves and get down to work. I know that this is still the ethos at the County. And here’s something else that graduates here all know….No one at the County works hard to impress the attendings. You didn’t work hard to impress your program director…You did it because when you looked over at the person next to you, they were working as hard or harder than you. Over time, you didn’t know anything else but hard work.
During my residency, I had friends at other EM programs, and we would compare our residency notes and talk about how things were going. So, when I told them about my program and all the extraneous stuff I had to do, my friends would just start cracking up. They would say “why would you do that to yourself?” The first few times this happened, I didn’t have any clever comebacks. I could not defend this insanity. In fact, there were more than a few occasions when I wondered whether I had made the right decision for residency. But each time I’d go back to a County shift and I’d see the nurses, techs, residents, and even the attendings working their asses off, I realized that I wanted to be just like them. No one complained when it was busy. No one threatened to quit when doing mandatory overtime. And they always showed up and grinded it out because they had grit.
But grit truly has more benefits than just working hard. Grit gave me a true appreciation for the jobs that other people do. I observed how hard the nurses worked… the techs, the clerks, the janitors all work too. I quickly realized that I was part of a very complex team who I couldn’t work without. Work hard and your team will notice it and appreciate it.
Lesson #2: Work Smarter, Not Harder
Now, it’s fine to put your head down and work hard, but you also need to be efficient. Doing everything yourself can only get you so far. To really take it up a notch you need to work smarter, not harder, and the County taught me that too…What I’m talking about here is innovation.
The best example I have for you was a resident who was one year ahead of me named Raffi. During my five years in residency, I ended up placing all but one IV, but Raffi got nurses to do his IVs and blood draws all the time. For a while, I couldn’t figure out how he managed to get this done, but then I stalked him (not in a weird way, like I’d quietly follow him on a shift and hide behind a garbage can and watch what he did). He’d go up to the nurses, put his arm around them, even the meanest nurses and start sweet talking them. He would say, “Hey there…..how you doin’? I like those scrubs. Are those new scrubs?” The nurses would all chuckle and swoon. Then he’d pounce and say, “Do you mind placing an IV for me in room 5?” And incredibly the nurses would do it for him. I thought to myself, whoa…. I’ve been doing it all wrong this whole time.
Now in full disclosure, I never quite figured out how to get nurses to do my IVs at the County. But I did figure out a couple of other ways to get some important things done. Every Friday and Saturday night was busy in trauma, and getting your CTs done first in the one 16 slice scanner was a huge source of pride amongst the residents. So, before my shift, I’d stop at Dunkin Donuts, buy a box of Joe and donuts and stop by the radiology suite to drop off a few gifts for my radiology tech friends. Needless to say, my CTs were always done before everyone else.
So, what is the point of all this? Is it to sweet talk, swindle, or bribe your way through residency or in life? Yes! The answer is yes, absolutely. Do whatever it takes to win. But the other message here is that whenever there are challenges in front of you, try to view your problem from all angles. Research and learn from successful people who are around you doing similar things, and then do your damndest to figure out a better solution to the problem.
Lesson #3: How to Talk to Patients
Not “HPI talk” to my patients, but getting to know who they really are and hear their amazing stories. Our patients do have some amazing stories. One of the masters of listening was an attending named David Dennihy. One thing he excelled at was connecting to his patients on a level that only a few could ever do.
One time we were doing walk rounds and there was a diabetic patient with gangrene of the foot who was being admitted for amputation. Dennihy pulled back the curtain and said, “Over here is Mrs. White. She’s a bad diabetic being admitted because tomorrow she is getting her foot chopped…Too many Snickers bars, right Mrs. White?” I looked on in horror and waited for her to burst into tears or punch him in the face. But instead she just started laughing and said, “Oh Dr. Dennihy, you cray-cray!” I was truly in shock…. How could this be happening with such a rude encounter? But what I didn’t see was minutes before, Dr. Dennihy was by her bedside talking to her, holding her hand, and she was the one making jokes about her diabetes and eating too many Snickers bars. His brief interest in her made her feel more comfortable with him and they joked like they were friends for years.
Over time, I practiced and honed these skills. And over the years, I’ve met some pretty incredible people. People who have jammed with Jimmy Hendricks and served in world wars, CEOs, and gang leaders. I recently met a man who served as the first black marine in a war. I’ve spoken at length to people who are dying from cancer, felt so alone, and just needed to tell someone that they are scared to die.
I always try to connect with my patients as a human being. Your patients will thank you for that, because too many doctors are busy typing notes while speaking to them. Too many doctors rush through their history, and few learn about the human being in front of them. Unfortunately, you may be a patient too one day, so please be sure to be the doctor that you wish to have caring for you. When you go beyond the HPI with your patients, you gain so much more from your encounter. Your job isn’t just more rewarding, your patients trust you more, their families listen to you, and the whole “doctor thing” is just a whole lot better.
Also, equally important, is to take the time to talk to and learn about people who you work with, from the security guard, housekeepers, and even the nastiest consultants. I often find that the meanest consultant is a jerk because of other things going on in their personal lives, not because of me. Sometimes some really heavy stuff. Stuff you would never know if you didn’t talk and connect with them. Now, while I don’t condone being rude or taking your frustration out on others, I’ve learned to be more tolerant of rudeness, because everyone around you is fighting some sort of war. You just never know what a person is dealing with, but by learning more about them, you’ll often find that they become a little more friendly.
Lesson #4: The Art of Being Kind
Now, the County didn’t directly teach me this, because, in all honesty, not everyone was nice at the County. But this was something that I observed in attendings who I revered and admired. Dr. Rinnert best exemplifies this concept. No matter how busy it was in the ED, he always said thank you when housekeeping changed the trash, he never engaged bitter consultants but would thank them for seeing his patients, and he would say good morning as he passed people in the hallway, even if he did not know them. This was very weird for a guy like me from NYC, because if a stranger in NY ever speaks to you, they are trying to sell you a bootleg DVD or you are about to be mugged.
But Dr. Rinnert was always friendly and personable, and as a result, his kindness created a positive atmosphere whenever he worked. People were kinder, they helped each other out, and mean consultants found it harder to be mean. Being kind is also self-healing. When you are kind, you start to feel good. It’s all about neurochemicals and shit that are released when you’re kind. I don’t understand it, but it just makes you feel better. Trust me on this one. When you feel good, you do better work, and you don’t mind working as hard as you do. It takes much more effort to be mean than it does to be nice.
Lesson #5: Strive to Be the Best Version of Yourself
I know, so corny, so cliché, but please hear me out. You will finish this residency, and be one of the best EM docs to walk this earth. But graduates, you hold the keys to elevating our specialty by continuing to be amazing doctors overall, not just good EM doctors. A man by the name of Mark Silverberg taught me this lesson. Silverberg was one of my mentors, and he’s been a mentor to most of you. One day early on in my residency I was trying to see a lot of patients and impress Mark, as we all tried to impress him. I saw a lady who came in for lower extremity edema but she looked really, really good, and there wasn’t much to do except get her to an outpatient follow-up. I presented the case to Silverberg and told him that she’s got leg swelling and it was likely benign lower extremity edema, and I wanted to send her off to her primary care doctor. He said “Okay Haney, well what’s your plan?” I said, “I plan on giving her a stack of discharge papers and saying goodbye.”
He shook his head and said, “Haney, when you graduate from here you can either be a good doctor or be a great doctor. I want you to be a great doctor and that means sometimes thinking a little harder about your patients and doing a little more rather than taking the path of least resistance.” So, we revised my plan, and I sent a BMP, liver enzymes, and did an ECG. And guess what happened? Everything was absolutely normal and she still went home with outpatient follow-up. Nonetheless, Silverberg’s lesson stayed with me forever. Emergency Medicine is a young specialty, and we still have a lot more to prove. Other specialties push us around, give us a hard time when we call for consults or to admit our patients, but the truth is we are an amazing specialty filled with brilliant people and we must always elevate our game to be better.
Grit, working smarter, not harder, talking to your patients, the art of being kind and striving for greatness are just a handful of lessons that I’ve learned from training at Kings County. If you remember nothing else from this today, remember this quote by Conan O’Brien, “In life, please don’t be cynical because, if you work hard and you’re kind, amazing things will happen to you”. Time and time again, I’ve found this to be so true in every single aspect of my life.
So good luck to you class of 2019, and good luck to everyone else in the room. I am truly proud that we are all on the same emergency medicine team and remember, no matter how busy of a shift that I may be having, I would always place an IV for you.
Thank you
-HM
rshah
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