The switch

"Is someone down?" asked T., who was driving. We were on our way back from an intern retreat day in the mountains, and while stopped at a traffic light, we had noticed a cluster of people standing in the oncoming lane of traffic. Looking out my door into the dark, I could make out three people looking down at a black umbrella. Under the umbrella was a body. "Yeah," I said, "someone's down."

I got out of the car, crossed the street, and ran toward the umbrella. S. was close behind me, and T. got out of the car and followed him. A young woman was lying down on the ground with her legs bent at the knees and turned to one side. Squatting next to her was a man with dreadlocks. As I ran toward her, I yelled, "Is she breathing?"

She was. She watched serenely as we each arrived on the scene, moving only her eyes as our faces came into view. She said, in accented English, "I got hit by a car." She looked as if she had laid down to take a nap.

We asked her questions. Can you breathe OK? Yes. Did you lose consciousness? Yes. Are you having pain anywhere? Yes. She had been hit at the hip and had some pain in her lower back, but she could wiggle her feet.

I realized with some shame that, while running toward the girl, all I'd been thinking was, oh my God oh my God it's dark she's down; there was, initially, nothing organized in my head, no clear thinking about what to look for when I got there, no clear thinking about what to do. A few seconds after I arrived at the girl's feet, I almost physically felt it snap into place-the training I had that taught me to look for airway, breathing, circulation, and the urgency of keeping her still.

Between the car and the girl, I felt like just another panicked person on the street. Standing in front of her, however, she became a patient, and I was suddenly able to think about what might be wrong with her, and what I might need to do.

Turns out, we didn't need to do anything. Fighting our instincts to intervene, we stood there in the dark road and talked to her until we heard the sirens. The ambulance arrived, and she was packed up onto a backboard and whisked away to the hospital. We thought to ourselves, she's going to be OK, and walked back toward the car.

Earlier in the day, at the retreat, we had had small group sessions where experienced physicians shared their wisdom and we nodded while thinking about lunch. I wonder now whether, for those experienced physicians, changing their framework for interactions from person-person to doctor-patient has become easier or harder. Do they become more or less receptive to people at parties talking to them about their bowel movements? Are they quicker or slower to approach friends who smoke about reasons to quit? Do they more fluidly make the switch between spectator and resuscitator when they see a person lying in the road?

Does being a doctor when it's helpful to other people become reflexive? Do I want it to?

In the car, someone asked, "What would we have done if she hadn't been OK?"

I responded. "Our best, I guess."