Off the Shelf 1169

like other texts, it discusses subtleties and nuances, not merely typical and classic ECG recordings. By no means an intro- ductory text, it contains insight for all reader knowledge levels; from first-year

medical student to expert cardiologist. The medical community and, more im- portantly, our patients have suffered a profound loss with the passing of Dr. Chou during the production of this edi-

tion; fortunately for us all, his master- piece lives on.-JACKSON D. SMOOD, MD, Oregon Health Sciences UniversiQ, School of Medicine, Portland, OR, De- partment of Emergency Medicine

Reflections

I READY FOR THE BIG LEAGUES Comments of a program director on the bittersweet occasion of the grad- uation of his first class of residents. Spoken to the assemblage of residents, faculty, families, and staff (June 20, 1996).

I The “personal statement” in Frank’s application to our residency began by saying, “Growing up in a suburb 10 miles north of the Bronx, New York, my childhood was filled with Little League games, Pop Wagner football, and Sunday suppers of homemade pasta amidst lively conversation with my family.” Frank was a catcher in Little League, and I remem- ber the early days of his internship much the way his Little League coach must re- member his early days as a player. I can imagine Frank digging in behind the plate, giving the pitcher the signal while he keeps a nervous, intense eye on the first-base runner. The pitcher sets, kicks, and delivers. The runner gets a good jump for second. The pitch is in the dirt but Frank scoops it up and fires down to sec- ond. He throws a “frozen rope” ankle high just to the right of the bag, but the runner beats the throw and is safe. The coach thinks, “That kid has a great arm. I’m lucky to have him on my team.” But Frank is upset with himself, kicks the dirt, punches his glove, and vows to get the next runner who tries to steal. He says, “Sorry, guys.” half to his team and half to himself.

That was Frank when he started his internship. Personally devastated by his first bad outcome. Angry and disap- pointed at losing his temper with a pa- tient’s overly demanding family. Wonder- ing if he would succeed. I knew, and the faculty knew, that Frank had all the tools to be a great emergency physician. A

quick thinker with good hands and a good fund of knowledge. We saw competence early on and we were just waiting for Frank to develop the confidence that he would need. We had faith in him from the beginning. Partly because he had all the necessary skills but mostly because he so clearly had a heart of gold.

His personal statement continues, “It must have been at one of those memora- ble family gatherings that I casually men- tioned my interest in medicine. From that point on, I was already a doctor in their eyes. I felt a daunting responsibility to fulfill their expectations.” During resib- dency, Frank had the responsibility of ful- filling those expectations in a way that none of us welcomes. His dad became ill and Frank was called upon to fill the dif- ficult role of the “doctor in the family.”

One of Frank’s letters of recommen- dation had referred to him as a “naturally sincere student who has shown a marked degree of professionalism, compassion, and empathy.” These are the qualities that Frank brought to his role in his fath- er’s care. He accepted, unflinchingly, the role of advocate, negotiator, interpreter, and informed source of reassurance (even when he feared the worst). And all the while he remained compassionate and empathetic. He filled the dual roles of doctor in the family and loving son.

Frank also has the gift, and it is truly a gift, to make us laugh. In college he was a great success on stage performing, among other things, improvisational com- edy. It was a potential career path that he gave up to pursue a career in medicine. During his interview prior to residency, I asked him why he didn’t pursue a career in stage comedy. This was the opportunity for him to give the old formula answer of, “That would have been nice for me

but pursuing a career in medicine will give me the opportunity to help others . . . ,” etc., etc. Instead, Frank answered, “To be honest, I bombed a couple of times and it really hurt.” That represents the final in- gredient that gives Frank the ability to make us laugh. He is not just enthusiastic, articulate, and clever. He is also humble.

Which brings me to the final balance that Frank has achieved. This balance is sometimes difficult for all of us. Some never achieve it. But Frank has achieved that elusive, necessary balance between confidence and humility. To achieve this, one must be both smart and sensitive. And Frank is, most surely, both.

Our Little League catcher has grown up. From behind the plate he surveys all of the players on his team. His wife, his new son, his mother, and his father are in the field. His colleagues, his patients, and his neighbors are out there too. He sur- veys the world of his family, his career, and his community. I am in the bleachers. His former coach. I know, and every player on the field knows, that Frank will do everything in his power to make sure nothing gets by him. The runner on first base now senses Frank’s confidence and stays very close to the base.

Frank, you are ready for the big leagues. This team will miss you. I will miss you.

STEPHEN J. PLAYE, MD Tufts University School of Medicine; Baystate Medical Center, Springfield, Mas- sachusetts

Department of Emergency Medicine

Address €or correspondence and reprints: Ste- phen J. Playe, MD, Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01 199. Fax: 41 3-784-8070.