Portal de Periódicos da CAPES

Emergentology

2016; Lippincott Williams & Wilkins; Volume: 38; Issue: 10 Linguagem: Inglês

10.1097/01.eem.0000503377.69186.b1

1552-3624

Graham Walker,

Paranormal Experiences and Beliefs

Figure: Dr. Ginno BlancaflorFigureMy first memory of Ginno Blancaflor was that he just flat-out refused to talk to me. My senior resident was busy seeing a patient, so I figured I might as well tell the night attending about the patient with wheezing who was feeling better after her albuterol treatment. She was already asking to go home. After a quick 30-second presentation during which Ginno stared right through me, he curtly said, “You should talk to your senior about this patient,” and walked away. Miffed, I started to tell the third-year what had just transpired, and she said, flabbergasted, “What?! You tried to talk to Ginno? No, no, no. Ginno does not talk to interns.” This was the first of Ginno's many rules I would come to learn. I remember being incredibly offended that night — Who does this guy think he is? He's above even acknowledging that I exist? — but as I moved my way through residency, it was easier to understand the rules he had set in place for his emergency department. Turns out, if you make the senior resident manage every case with his intern, it forces him to get better at managing a team and also keeps the attending from drowning in intern minutiae. (Ginno was also one of those physicians who is such a stickler for his own rules that you would want to roll your eyes, but he was right so much of the time that you wouldn't be annoyed with him by the end of the shift.) Ginno died suddenly in June from lymphoma, at age 45. He was cared for by a family of emergency physicians, nurses, and paramedics, including some he trained. Our residency is still trying to recover, and misses him dearly. Ginno was a nocturnist for, I believe, almost his entire career. It makes sense that he would have his rules; there is no better way to keep track of the insanity of night shifts than by making standards for one's practice and sticking to them. Some of my favorites: All patients get undressed and in a gown. ALL. NO EXCEPTIONS. It didn't matter if the patient only had a hangnail, Ginno would not examine the patient until he was gowned. All chest pain gets admitted. Ginno sees the patients separately, and you may come up with your own theories about the patient, but Ginno is calling the shots. There's always time for a smoke break. You give Valium to patients with alcohol withdrawal. (He would then launch into a mini-lecture on the half-life of valium and its metabolites.) He was far from the nicest attending; in fact, he could be a little gruff, sometimes even bullying the patients into getting a clear history out of them. (Such is New York City emergency medicine.) But when he was ready to hear your cases, he somehow could always pull the salient, subtle, case-clenching details from a 30-second interaction with the patient. “Neuropathy, yes, uh huh, I agree. Oh, you think it's diabetes? She doesn't have diabetes. She's not on any meds for diabetes. Her last Chem7 was normal. (Pause for effect.) Did she tell you that she works with ceramics? Her neuropathy is probably from cadmium toxicity, but, sure, I guess you can send some labs and a hemoglobin A1C on her if you really want.” It wasn't intentional, but Ginno was so smart that it made you feel dumb. Ginno's death made me think about how much we should appreciate the nocturnists in our lives — in our own specialty as well as others — for their commitment to taking care of night-shift patients (which we all know are different from day-shift patients). That old adage, “Everyone's a Democrat until he has a mortgage,” could probably be changed to “...until he works a run of night shifts.” Our nocturnists really have a special subset of skills, especially among emergency physicians and night-shift nurses. How can we begin without discussing their incredible BS meters? They see such a large amount of nonemergent disease, along with so much psycho-social strife that sometimes it can be difficult to tell the alcoholic in AKA or drunk teen with the subdural from the garden-variety intoxication. My experience is that nocturnists are pretty darn accepting of patients who need overnight babysitting. The intoxicated patient who is probably going to need a good eight hours to sober up? Your nocturnist isn't going to put up a fuss. (As our night shift says, “That patient is going to be a DSP — day shift problem.”) Let's not forget their commitment, either — working nights for your department means fewer nights for the rest of us. I know my family can see a stark difference between Night-Shift Graham (zombie mode) and Day-Shift Graham (hyper, loud mode). Thank you for your years of service and dedication to patient care at often the least opportune times, nocturnists. And while I never got to say it, thank you, Ginno for teaching me your approach to so many parts of emergency medicine — from ABGs to diagnosing zebras — once the patient was in a gown.