My family was driving to see our new niece this past Saturday. While passing through a town on the way, we came upon a motorcycle accident.  The rider had been hit by a vehicle and was lying on the pavement with a growing crowd of people who wanted to help.  I’ve done it before.  I did CPR at the scene of a wreck when I was in medical school, and have contributed a bit to several other incidents down the years.

“You should stop,” my wife reminded me.  “Yeah, yeah, I know.”  My two high-schoolers craned their necks around to watch what was happening.  I pulled over in a safe parking area and walked back to the crowd, the pieces of motorcycle and the injured rider.  Over the years, I have learned when to stop and offer assistance.  My criteria include situations where someone is lying on the ground immobile, situations involving lots of blood and any accident where individuals who are responding appear stressed or are waving their arms frantically.

I walked to the scene of the accident to see a bystander securing the patient’s cervical spine, and several others holding him down.  He was confused and asking repetitive questions.  One eye was staring to the side, out of alignment with the other.  (This is called a “dysconjugate gaze,” and can be a marker of brain injury.)  The person holding his neck reported an open head injury.

“Hi, I’m an emergency physician.  How can I help?”

Bystanders looked up with passing interest which faded immediately to disinterest.  Maybe it was the cargo shorts.  Or the lack of name-badge.

“You’re an ER doc?”  one asked.

“Yes, what happened?”

There was a brief summary, and I inserted myself in the situation to help keep the patient immobile.  Somehow one bystander ended up on the phone with the 911 operator.  I examined the victim in that cursory way that comes from years of emergency medicine.  Clammy.  Speaking without stridor.  Breathing slightly rapid but also agitated. Pulses intact and pink nail beds.  Moving everything but confused, more repetitive questions. No gross bone injury. Chest with no deformity.  Abdomen non-distended.  Pelvis stable.   This takes, for most of us, a minute or less.

“What’s her pulse?  I need a pulse!” said a bystander.

I responded, gently, “He’s talking.  He has a pulse.”

EMS arrived.  “Everyone who isn’t holding C-spine, step back.”

And we did, as the patient thrashed and reached a bloody hand to the arm of the one person remaining.  She gave the report.

I walked away.

The thing is, I really don’t have a huge ego.  I want to help.  But this isn’t the first time I’ve been upstaged by anyone and everyone else, from first responders to nurses and EMT’s.  Believe it or not, I have a large skill-set, based on years and years of caring for trauma victims.  In the end, however, I want to stop less and less.

Maybe it’s the fact that I realize that I, that any of us, have little to offer without our tools, gadgets, and diagnostics. Airway, C-spine, pressure on bleeding wounds, a round of compressions or two (which are mostly useless in traumatic arrest).  Maybe it’s the fact that responders don’t see me acting very “doctor-ish.”  No lab coat, no stethoscope, no orders barked loudly and with profanity.  It’s not how I express my doctor self at work either.

Or perhaps it’s my sense that in the age of the Internet, in the age when everyone has scrubs and a certificate from a medical assistant program or some other credential, in an age when everyone can watch and learn from “Trauma, Life in the ER,” nobody really cares what I think.  I’m just another schmuck getting in the way.

Oh, I’ll keep stopping. There may be a time when I can make a difference.  But I won’t expect much response from identifying myself as a physician.

Maybe I’ll get a Patrick Dempsey mask.  At least then someone would believe I had something useful to offer the patient at the side of the road.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of the Practice Test and Life in Emergistan.

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