Zach Jarou, MD
Vice Chair
EMRA Editorial Committee
Denver Health
Denver, CO



AILURE. It’s something with which

we often don’t have a great deal of
experience, or something that we
often ignore. Most of us have worked
hard our entire lives to succeed and
overcome, and for those of us just entering
the medical profession, failure often yet
hasn’t been a part of our lives. After all, we
wouldn’t have made it this far if we didn’t
excel at jumping through hoops, making
the grades, and continually striving
to be the best we can be. However,
life doesn’t always go our way —
eventually we will fail. We are not
infallible. Whether it is in the classroom
— or worse, in our caring for patients —
eventually we will all experience failure
and disappointment. As physicians, we
are trained in how to deliver bad news
to our patients, but how do we deal
with being on the other side of the
conversation We’ve learned KublerRoss’ stages of grief — denial, anger,
bargaining, depression, and acceptance —

Speaking from experience
I will never forget receiving the news. It
was halfway through my third (and most
just returned from a much-needed winter
of pediatrics. Inside of the small exam
room, my little patient and I were startled
by the piercing beep of my pager. Probably
another misdialed number, I thought,
having only received a handful of pages in
the months since the device was assigned to
me. Requiring students to carry pagers in
an era of text messaging and smart phones
always seemed more like a hazing ritual
than a useful means of communication.
Unfortunately, the page was intended for
me; when I called it back, I was surprised
to hear the voice of the OB/GYN clerkship
director on the other end of the line.
I was informed that due to “professionalism issues” cited by one of the residents
30 EMRA |

Whether it is in the
classroom — or worse,
in our caring for patients
— eventually we will all
experience failure and

I had worked with for only a few days
I would be required to do a month of
remediation before I could receive a
grade of conditional pass.

DENIAL. My stomach dropped. What
had I done to deserve such a poor
evaluation from someone whom I barely

ANGER. It was no secret amongst my
classmates that this was a malignant
rotation. The residents were a miserable
bunch and seemed to derive some sort
of twisted joy from treating us like dirt.
throw me under the bus and threaten my
future success without ever speaking to
that’s unprofessional. For the next several
weeks, I couldn’t think about the whole
ordeal without my blood boiling.

The Road
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,
And both that morning equally lay
What I thought I learned
The power disparity was striking. Multiple
rounds of appeals yielded no results. In
arbitrators, the unsubstantiated claims of
the resident would always trump the word
of the student. I had been systematically
denied the opportunity to speak face-to-



ACCEPTANCE. The uncertainty and
a losing battle had taken its toll on me.
For my own sanity, I had no choice but
to accept my fate. I was done dwelling in
the past. As my anger subsided and my
perspective enlarged, I came to embrace
that, in the grand scheme of things, it
wouldn’t kill me to do another month of
OB/GYN. I felt it was unfair, but it was my
best solution to move forward, which, by
that point, in time was all I really wanted.

What I really learned
(the road not taken)
Orange is
The New Black, I may have lived my entire
life never understanding the true message
of American poet Robert Frost’s “The
Road Not Taken.” A quick line of dialogue
between the show’s characters prompted

Not Taken
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I —
I took the one less traveled by,
And that has made all the difference.
— Robert Frost (1920)

face with my accuser in the presence of
a mutual supervisor. I was confused and
without an advocate.

I had asked for more feedback. If only
I had constantly reported the most
mundane of my activities to the senior
residents so that there was no question
as to my whereabouts at all times. If only
I had been more of a gunner and tried
to steal patients and procedures away
from the other students to show how
truly interested I was. If only I hadn’t
accidentally nodded off for those 5
minutes during that one lecture. If only
I had brought in more snacks for the
residents, then they would have given me
good reviews.

DEPRESSION. I felt helpless and alone.
How on earth would I land my dream

BARGAINING. What could I have done
they had chosen for themselves. If only

There didn’t appear to be any light at the
end of the tunnel.

time in years. I had always believed that
“taking the road less traveled” was a
manifesto for breaking away from the
crowd and blazing your own trail. I was
amazed at how wrong I had been. There
it was — in black and white — both paths
appeared exactly the same. There was
no road less traveled. The traveler
made a choice between two equals. It is
only “somewhere ages and ages hence”
that he claims he took the road less
traveled, which “made all the difference.”
This isn’t a story about individualism or
adventure, it’s a story of wanting to
believe that the choices we’ve made
and the experiences we’ve had were
So what does this century-old poem have
could possibly come from experiencing
I’ve learned to
take a step back to gain perspective when
things seem overwhelming. I’ve learned to
hold my head high in the face of adversity.
I’ve made my challenges public so that
other students can know that they are not
alone in their own similar situations. I have
I know in my heart that this experience
has better equipped me for the inevitable
challenges that the future surely holds. I
have taken the road less traveled —
I’ve become resilient — and it has
made all of the difference.
June/July 2014 | EM Resident 31

Official Publication of the Emergency Medicine Residents’ Association
June/July 2014
VOL 41 / ISSUE 3

Solving Cases
Using ultrasound

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