Do Your Damn Job

I met Ken Smith, in 2009, when I came to St. Louis Children’s Hospital to pursue training in pediatric emergency medicine. By that time he had already been working there as a nurse for 13 years, before the 13 years we worked together. Despite the amount of time I spent working with him, I was surprised how few stories I have to tell about him.

Then I realized why: he’s not a part of my stories because I was likely a part of his. Ken was a story-teller, and everyone he met was a character in his tales.

To meet Ken is to hear him harken back to his days as a travel nurse. To hear Ken is to have him regale you with work stories of wild and out-there patient (or parent encounters). To work with Ken is heed his wisdom when he says in a joking-not-joking voice that a boss somewhere needs to say to their staff, “do your damn job.”

No, my lack of stories about Ken is not from a lack of memorable encounters. It is because to know him is to be in his audience. It is because every encounter with him has the potential to be a parable in a compendium that rival Aesop’s Fables.

Not a cliché

We suddenly lost Ken almost 3 weeks ago, on August 14th, 2022. I say “suddenly” in a way that I hope resonates beyond the cliché.

To know Ken was to know a steady, constant presence. Ken showed up 30 minutes before the beginning of every ER shift, and managed to keep an even-keeled demeanor for over 12 hours.

When’s the last time you spent 12 hours anywhere and stayed calm? Now imagine doing that in an ER, which I often compare to a casino — constant beeping, no sunlight, and people puking followed by a request for drinks (apple juice instead of vodka).

Yes, Ken was human. The difference is if he complained, when you suggested a solution, he would give a wry smile and a dry laugh, then let you know he already knew the solution and took care of it. Then he would turn around, and you could feel him smiling as he went right back to work.

Because more than anything, you knew that when the shit hit the fan, Ken would be calm, and he would already know what to do.

Room 1

I do have one Ken Smith story. It was at an inflection point in one of the most difficult periods of my professional life, several years ago.

I was sitting in the physician work area in the morning during a slow ER shift. Or slow enough that I was able to sit at a computer completing charting undisturbed while the residents saw new patients.

Then I heard Ken’s voice behind me.

“Fahd. Room 1. Now.”

Room 1 is our main trauma bay. Patients are placed in Room 1 for two reasons: either they are coming via EMS and we are activating our trauma system, or they come in the front door with family or friends, and someone thinks they are so ill we need to activate the trauma system.

EMS was not bringing us a patient.

Ken did not sound alarmed, just urgent. I turned around, and saw him moving quickly through the work area, which connects to the back hallway leading to Room 1.

He was holding a limp child in his arms. I jumped up and went with him.

He laid the child on the stretcher — I saw they weren’t breathing and checked and could not find a pulse. I jumped on the stretcher to start compressions. Then I saw bruises on the child’s chest, and told him to activate the trauma system.

Of course, he already was on his way to do it.

The room quickly filled with people — it was a weekday morning and every possible resource was available. It was a quietly and efficiently run trauma, which does not happen as often as one would hope.

I was “running” the trauma — acting as team leader, directing various people in the room, talking with Ken, collaborating with the trauma surgery attending, and ultimately, the one responsible for telling a family their child had died.

What Ken didn’t know, and what no one else knew — not my co-workers, my family, nor my friends — was I was in the midst of a severe emotional crisis.

Imposter Syndrome

Only a few days prior, a child I cared for died shortly after I led a prolonged effort to resuscitate them. I left that shift wtih my confidence shattered, blaming myself, and with a severe case of what we call “imposter syndrome” — doubting my abilities and feeling like a fraud. I was married at the time and told my (then) wife, but no one else.

When I went back for my next couple shifts, I was absolutely terrified that another critically ill child would come in, and somehow I would not only be unable to save them, I may contribute to or cause their death.

When this next child died I went out to the ambulance bay and started bawling. Not because I thought any one of us, including myself, had made a mistake. I was bawling because I knew we didn’t make a mistake and still couldn’t save the child.

However, had I been able to identify even a single thing we could have done better, had the trauma bay been too loud, had the resuscitation felt disoraganized, had a procedure been unsuccessful, I would have left the room “confirming” my own self-doubt and imposter syndrome.

I don’t know if I would have been able to continue working. I don’t mean finish my ER shift — which I did — but continue working as a pediatric ER doctor at all. If that sounds dramatic, it isn’t. Many physicians have left medicine entirely because of such experiences. Two such encounters within a week could easily have been enough to completely crush me.

What made this second encounter different? I’ve thought about this plenty, and I have to think one of the most important factors, if not the most important, was Ken.

Everything we do in a hospital is a team effort, especially in an ER, and even moreso when taking care of a critically ill patient. We rely not just on “tangible” skills such as placing lines or tubes, but on our ability to work together and communicate. We need a calm environment and excellent communication.

It just so happens those are two areas Ken excelled at fostering. Had he frantically yelled for my attention instead of calmly telling me to go to Room 1, my cortisol levels would have been mich higher.

Had he not already been steps ahead of me in the trauma bay (not just physically but mentally), my stress level would would have been way higher.

Had he not been so quick to communicate and coordinate, making my job of “running” the trauma much easier, the potential for any error would have been higher.

Despite me being filled with self-doubt moments before this patient arrived, I was able to stay calm until the end. I walked away not with restored confidence in my abilities, but at least recognizing I was not incompetent. That may sound silly to some, but it was that recognition that let me fumble through the next few months.

The encounter gave me a reprieve that eventually led me to grow and learn to process grief in a healthier manner. Without that reprieve, without his calm, I can’t fathom what direction I would have gone.

Celebration of Life

I have a level of gratitude for Ken I can’t really capture in these words. I have shared portions of this story publicly in specific forums, speaking to other healthcare workers about the trauma we deal with as healthcare providers. When I do, I try to always mention Ken by name, but it was only recently I realized how profound his presence was on me.

One thing I never did was talk directly with Ken about these experiences. I don’t know why.

Maybe it’s because I thought he already knew.

Maybe it’s because I didn’t know how to share a vulnerable moment with a man who could seem invulnerable.

Or maybe, just maybe, I knew what he would say. That despite heartache or self-doubt or self-pity, ultimately he and I were both there for one thing: to do our damn jobs. And you know what? We did.

Doing our jobs doesn’t mean we get the outcome we want. A child dying will always a be reason to grieve, and we are not immune to emotions. But it does make a profound difference for the doctors, nurses, and everyone else caring for a child, if we know we truly did the best we could, because anything less means we may have missed an opportunity to save a child’s life.

I’ve learned the hard way we can’t take care of others if we don’t take care of ourselves. It took me a long time to process my grief from those patients. Eventually I worked through it, which is the only reason I’m able to now write these words. I learned that writing or speaking is my way of processing my grief.

Unfortunately the ER doesn’t close its doors when a patient dies. Patients keep coming, and a family in Room 25 never knows what is happening in Room 1. If a beloved co-worker dies, they do not see the tears shed by staff. Yes, including tears shed by me when I heard Ken had died, again as I tried to write this, and a few times in between.

But in true Ken fashion, rather than a traditional funeral, his family is holding a Celebration of Life. This is how Ken would want us to remember him.

While we each should process grief in our own way, we should honor people the way they want to be honored. I think doing so will also help our own grieving process.

I can think of no better way of honoring Ken than a Celebration of Life. By sharing our stories of him. By laughing and smiling around the tears. By writing the epilogue to his compendium of tales. Then by showing up early for our next shift and doing our damn job. That is how you honor Ken Smith.