Watching the wheels.

People who live here often remark that Chicago has two seasons: winter and road work. If the city was a heart and the highways were coronary arteries, an aortic balloon pump would be needed in short order. Traffic is horrendous. As I am writing this editorial, it is summer, meaning the Cubs are wallowing in mediocrity and the roads are being repaired, repaved, or resurfaced. I drove to work today dodging roadblocks, obstacles, and the general mayhem set up by the Illinois Department of Transportation. Amid the concrete trucks, traffic cones, flags and warning signs, I came across the same scene that is repeated every day of the summer: five people in shiny yellow vests and hard hats with metallic reflectors watching one poor guy dig a hole. For whatever reason, it seems that most people strive to be in a position to watch other people do work. It is the American way. I guess you know you've made it then. I have come to the realization that in an odd sort of way, the five guys watching a hole being dug are all similar to me. Nearly everyday, I spend part of my day in leaded glasses behind leaded glass watching residents or fellows perform image-guided procedures. I guess I don't have people watching me watch other people do work, but it is not that different in many respects. Maybe roadside foremen need to continually teach junior colleagues how to dig holes like I teach house staff to put in central lines. I wonder if, like me, foremen occasionally treat their trainees like a long mechanical arm—that doesn't quite do what you want until you begin screaming. When I first joined the ranks of academia, I never left the interventional radiology suite during cases. I think this was mostly because I hadn't progressed through the last stage of the “see one, do one, teach one, rescue one” interventional radiology cascade. Over time, I was dragged into enough messes to feel comfortable in most situations and also realized that both my radiation badge and spine were happier if I spent at least some of the day outside of the rooms, away from the leaded aprons. Moreover, in a practical sense, it is impossible to train fellows if you immediately take every case away from them when they begin to struggle or stand over their shoulders making disparaging comments. Communicating with your fellows from outside the room is an art. You need to instruct but not undermine your trainee's autonomy. You need to direct care without unnecessarily alarming the patient. These tasks can be difficult to accomplish especially when minimal sedation is used and patients are already anxious. In the past, I tended to use the intercom but I found that if the volume was set up incorrectly, my booming voice tended to make everyone uneasy. People wondered if I was alert and oriented times 3 when I constantly asked, “What are you doing? What month is it?” One patient even called me a wizard; he heard my voice but never saw me. I think that in the stupor we call moderate sedation, he thought I was the Wizard of Oz. Or perhaps my fellow at the time reminded him of the Straw Man because he didn't have a brain. I'm not sure which. Subsequently, I started to type messages on the fluoroscopy monitor. This has many advantages because you can direct the fellow but patients are not privy to your comments. It is liberating when you can write what you could not otherwise say aloud; it is also a lot of fun. My messages consist of phrases such as, “puncture right here” or “you're in a vein, not the artery,” or “are you trying to set some record for longest permacath ever?” or “What month is it?” I guess this is part of the circle of life. You start out as a medical student watching procedures, then play a small part in them as a resident. Later, you actually perform some procedures after training, then do less and less until you're watching them again. This almost exactly parallels life. When you're young, your mother picks out your clothes and dresses you, and decides how to cut your hair. You have to ask permission to do anything. You eventually learn to dress yourself and achieve some measure of independence. Then you get married and you have to ask for permission to do anything again and your wife picks your haircut, your clothes, and dresses you. Hakuna matata. At least I get to choose which way I drive home today. I wonder if the hole is done.