Physician-author Tom Combs on life in the ER, nurses and his book, “Nerve Damage”

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Voted by physician and nurse colleagues alike on several occasions as one of the Twin Cities’ “Top Docs” per Mpls.St.Paul Magazine, physician-turned-author Tom Combs, MD clearly navigated the world of high-volume ERs for more than two decades with skill and grace.

Then in 2007, deep into his career as a staff ER physician at North Memorial Medical Center in Minneapolis and associate clinical professor at University of Minnesota Medical School, Tom suffered an SAH (subarachnoid hemorrhage). While recovery is still underway, the consequences were such that Tom was unable to continue practicing emergency medicine. Undefeated, Tom turned his attention to his second passion: writing. Now, we are absolutely pleased to announce the arrival of Tom’s first novel, the medical thriller Nerve Damage.

However great Tom’s struggle, it did grant him a unique opportunity to experience emergency care, followed by a long-term process of recuperation from “the other side of the rail.” We here at Scrubs were fortunate enough to chat with Tom about his ongoing connection with nurses, both as a colleague and a patient.

Here’s what Tom had to say about his physician/nurse working relationships, the unique challenges of healthcare and the ways in which he not only appreciates, but also very much admires the work that nurses do:

Q: I see that you have a great deal of experience in emergency medicine/trauma. What is it that drew you to this type of work?

A: The ER is immediate. The circumstances are generally intense and people are in real need. Every shift we have the opportunity to relieve pain, allay fear, save lives or comfort those who are hurting. The people who work in acute medical care, from pre-hospital through discharge, all share the desire to help others. We may gripe or moan, but fundamentally we all want the same thing.

It’s incredibly gratifying to help people in real need. The range of medical conditions and challenges are limitless. The fast pace and shift work are both a blessing and a curse. Relieving suffering and saving lives is noble work. The people who do so are special folks.

Q: How would you describe your working relationship with nurses throughout your career as a medical professional?

A: It’s been one of the genuine pleasures of my medical career. Working as an ER doctor in high-volume, high-acuity ERs guarantees the recognition of and respect for nurses.

Nurses also have a great senses of humor—it’s virtually a requirement. It was a rare and lousy shift if I was not, at some point, laughing hard with nurse colleagues, though it may have been something that others would not follow.

I am friends with a great many nurses who are men and women from my years in the ER. In some respects, these friendships have something that my non-healthcare relationships don’t. My nurse friends and I have worked together trying to save those in desperate need. We’ve shared the blast furnace of emotions that the successes, tragedies and deaths that are part of our work trigger. I respect and admire nurses, and I’m grateful to have so many among my friends.

Q: Is it common for nurses and doctors to have close working relationships or is there a fairly strong division?

A: I’ve been lucky (luck is a recurring theme in my life) to have worked at great institutions with incredibly strong physician and nurse colleagues. Close working relationships have been the rule.

There are occasions where strong-minded, committed folks have differences. And certainly, the intensity of what we do causes stress. But despite those challenges, I’d say that close working relationships are common.

Doctors and nurses are more alike than different, care about many of the same things, share a similar sense of humor and have done our best to help others. We share the same goal: helping patients. Medicine is a team sport—no one does it alone. We succeed brilliantly at times and face tragedy and death many others. What other people share such a bond?

Q: What is it you think that contributes to the common misconception that nurses and doctors are often at odds?

A: I’m no Pollyanna—I know that negative behaviors are a daily occurrence in our work. Some doctor behaviors (e.g., rudeness) make me ashamed. I’ve confronted several in my years. I also observe unfortunate exchanges/comments among nurses. But we all have our moments (I can look in the mirror here).

I believe the incredible challenges of our work cause stress that can be reflected in negative interpersonal behavior (being “at odds” with one another). Doctors and nurses face incredible pressure, and the expectation for caregivers is continuous perfection. These are tough roles that are both physically and emotionally demanding. Mutual respect and recognition among teammates goes a long way.

Healthcare, and nursing in particular, is a demanding, sometimes underappreciated, special job that really matters—every man and woman in the profession should take pride in the noble work they do. It is my hope that mutual recognition and support continue to grow among all in healthcare.

Q: Are there certain areas and/or scenarios during which you would rely on nurses and their daily interaction with patients to make a judgment call?

A: In the ER, patient/doctor interaction is generally a matter of minutes or hours, not days. In this setting, nurse judgment is particularly crucial. Constantly working under the strain of time and patient volume—our period of observing patients is short. Missing any aspect of a patient’s condition or circumstance can result in inadequate care, injury or death.

Often, nurses may elicit an essential part of history from either the patient or a family member. They may have observed a behavior, a physical finding or care limitation that I had not appreciated. It is dangerous not to consider the input and judgment of an experienced ER nurse.

In a busy ER, nurses are constantly making judgment calls. Typically, nurses will perform most triage (essential and challenging). Charge nurses are constantly trying to fit 10 pounds into a five-pound sack as they make major decisions on patient placement, patient severity, nurse resource assignment and so much more. We often collaborate on such strategic decisions.

The answer to the question—relying on nurse judgment is a giant “yes.”

Q: What are the top three qualities that the nursing profession demands?

A: Just three?! I think the fact that I can’t stop at three speaks to the demands of the profession. Here are a few essential qualities: common sense, communication, competency (including intelligence), caring, humor, emotional intelligence, sensitivity, physical stamina and more.

Q: Do you think this differs from doctors? If so, how?

A: In some subspecialties (e.g., strictly procedure-based) or nonclinical fields, doctors can be effective (annoying but effective) with bad communication. Not aware of any nursing roles where that would fly. Actually, it occurs to me that the annoying docs probably get by because skilled nurses fill in the gaps.

Q: Do you experience another side of nurses now, as a patient?

A: When I entered the stabilization room, I already knew I had a subarachnoid hemorrhage, having diagnosed many. I was rolled into the stabilization room, and seeing Laura (my ER doc partner) with nurses Margaret, Bruce, Meg and others, I knew immediately that I was in good hands. I was starting to fade out, but I wasn’t afraid. Knowing the skills of the incredible nurses taking care of me was a huge part of my confidence.

Q: What is it you see/feel from the other side of the tracks?

A: I spent 10 days in the neuro-trauma ICU. Things are pretty hazy for most of that time, but I do remember the nurses. Always supportive, patient and skilled—I just knew they could handle whatever happened.

I recall being uncooperative. I can’t remember which nurse it was, but she came in and somehow redirected me, getting me to do what was best for me. Great skill.

That was seven years ago. About two months ago, I was the guest of the Neuro Trauma ICU book club. They were awesome and said great things about Nerve Damage. Many of the nurses who had cared for me attended. It was very emotional for me. Great nursing means so much. I was in a bad spot and had fairly nasty cognitive deficits (e.g., could not read for over a month, had forgotten a lot, short-term memory was zip). But I’ve been lucky and have recovered beyond any point I had the right to expect. I know that the skills and caring of nurses played a huge part in my “luck.”

Q: You’ve recently written a medical thriller. Can you say a little bit about the role that the nurses play in the novel?

A: Some of my favorite scenes involve nurses. I like to believe that I revealed the skills, commitment and strength of nurses. Here’s an excerpt that demonstrates a nurse as a patient advocate, regardless of pressure:

Drake looked. “This tube has a lot of subcutaneous air tracking around it. Dr. Rainey, did you oversee the procedure? Were there problems?”

“Ah…yes. Yes, I did,” Dr. Rainey said. “There were no problems.”

Drake glanced up, finding Tracy staring at the big man with her mouth agape.

“That’s not right,” she said, shaking her head. “I was in here when your resident doctor did the procedure. You were on the phone. The whole ICU overheard you complaining to the head of surgery about the hypothermia.”

“Be quiet, nurse. This is between doctors,” Rainey said, scowling down at her.

“I will not,” Tracy said red-faced. “This is about a patient and his care. I absolutely will not be quiet.” She stood, jaw thrust, with her five-foot-two inches and one hundred-some pounds facing the massive doctor.

He drew back, his brow furrowed.

Tracy turned to Drake. “I’ve assisted on a lot of chest tube placements, and the resident had some trouble. He couldn’t get the tube to advance into the chest. He had to go back with the scalpel a second time.”

Q: Are any characters (nurse or not) inspired by a real-life nurse counterpart?

A: The short answer is “yes.” This is true for most of the characters in the book. I take one feature or characteristic of someone “real,” but fuse it with others or add in completely created aspects.

Overall I feel the results reflect authenticity of character. Nerve Damage includes an ER charge nurse (a fairly prominent character), a few other ER nurse characters (lesser but distinctive), a prominent ICU nurse character and a number of additional ICU nurse characters. Also some PACU nurse characters. I’ve received a few communications from nurse readers who thanked me for my representation of nurses. I also was told by another nurse that “You must have been a nurse in another life.”

I considered that high praise.

Q: Now that you are unable to practice emergency medicine, how has writing a medical thriller helped fill that void?

A: The thousands of hours that I have applied to developing my writing skills over the past six years (the first year, writing was beyond me) have been incredible therapy. Daily physical workouts coupled with the cognitive challenges of writing have been therapeutic.

After my bleed, my children were screened and my daughter was found to have a brain aneurysm. It has been rendered no risk via an interventional radiologic procedure. How amazing is that?!

Q: Do you plan to continue writing about medicine? Or in general?

A: I’m deep into book #2 with ongoing suspense, action and drama centering in the ER, ICUs and wards of “Hennepin-North” hospital.

I cannot imagine that I will stop writing. I’m looking forward to several books in this series. The drama, emotional intensity and personalities in medical care make it incredibly fertile ground for dramatic fiction.

Nerve Damage, Tom Combs’ debut thriller, explodes with suspense and true-to-life medical action as renegade agents of the trillion-dollar pharmaceutical industry place a young Twin Cities doctor and his family in deadly peril. It is a tale of heart-pounding thrills, brilliant twists and gut-clenching emotion.

For more on Nerve Damage, find it on Amazon here.

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