Portal de Periódicos da CAPES

First Person

2021; Lippincott Williams & Wilkins; Volume: 43; Issue: 2B Linguagem: Inglês

10.1097/01.eem.0000734900.39361.c4

1552-3624

Gerald F. O’Malley,

Obesity and Health Practices

FigureFigureAnthony Bourdain chronicled the life and times of a line chef in a busy restaurant in his book Kitchen Confidential. He described the pressures and frustrations of having to work for someone (the owner of the restaurant) who frequently had no idea how a kitchen runs or how a restaurant can turn out 250 dinners in four hours every night. A chef works holidays, weekends, and odd hours when other people are at home with their families. Mr. Bourdain detailed the tremendous beating his body took working in a busy kitchen: the aching, gnawing back and neck pain, the burned and gnarled hands, the bruised and battered knees and elbows, the throbbing pressure in the feet. And it seemed, despite his best efforts, that there were nights when no one was happy with the work he did. I thought Mr. Bourdain was describing me. That's exactly the way I feel after 25 years working in many blood- and coffee-stained EDs in every corner of the country. It is really astounding how similar the job of a busy emergency physician is to that of a line chef or even a head chef in a busy restaurant. Reading Kitchen Confidential and his other books and watching his TV adventures gives one the distinct sense that Mr. Bourdain genuinely loved his work, despite the mental frustrations and physical erosion. He described the kind of chef he most frequently hired and most often admired as those who showed up on time, ready to work and make the meals exactly the way Mr. Bourdain instructed them. No frills, no creativity on the part of the line chef. He didn't need someone coming to him in the midst of a busy dinner hour with new garnishes and side dishes; he needed someone to do a job and do it well over and over again. He didn't need artists; he needed craftspeople to run his restaurants. Mr. Bourdain prided himself on being a really good line chef, a craftsperson. I believe that is what good emergency physicians are, craftspeople, those who has dedicated a substantial portion of their lives to learning a skill and practicing that skill over and over and over until they can do it well every single time. Some craftspeople become so good that they become experts in their fields; we all know someone like that: a teacher or colleague or mentor, someone who just seems to glide through the ED like Bruce Lee, engaging, deflecting, and parrying any and all assailants while maintaining an inner calm, buoyancy, and happiness. One craftsperson can recognize another: We know one when we see one. I can't tell you if my car mechanic actually knows what he is doing or if my plumber really needed to tear out my drywall to access the pipes, but I can watch another EP sew a laceration, intubate a drunken trauma patient, pull a bug out of a kid's ear, cardiovert an unstable rhythm, field a half-dozen phone calls while interpreting five ECGs and three x-rays, make a pot of coffee, and walk a student through a shoulder dislocation effortlessly. It's the craft and the craftsperson. As a craftsperson, I don't have much patience for anyone trying to tell me how to practice my craft, especially administrators or other specialists, even EPs who don't work nights. (Sorry. That's part of the craft. If you won't work nights, weekends, or holidays, don't talk to me). I'm sure if I needed to, I could figure out how to remove someone's appendix. It wouldn't be pretty, but I'm sure I could do it successfully. The same principle applies to the surgeon who thinks he can come down and run the ED (practice my craft) as well as I can. Sure, the surgeon will probably survive the shift, but the ED will be a dumpster fire. Young physicians need to learn how to be good craftspeople. You learn the craft, and then spend your life practicing it, over and over and over until you do it expertly every time. Mr. Bourdain explored craftspersonship in other venues. He hosted a web series called “Raw Craft” for three years in which he interviewed master craftspeople in their workshops: knifemakers, cobblers, a traditional tebori tattoo artist, custom motorcycle builders, a metalsmith, and many more. I suspect if Mr. Bourdain hadn't died, he would have eventually gotten around to profiling a master emergency physician hard at work in some ED somewhere, an expert at the craft.