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I chose to work in Emergency Medicine because...
My choice to care for sick and injured children can probably be directly attributed to the fact that my father is a holocaust survivor who lost most of his family members at a very young age. Its my belief that his instinct and desire to be a problem-solver and to do things that made a difference for people who are suffering directly influenced my life.
Children are very vulnerable human beings, and when they are sick or suffering, it can have a tremendous impact on them and their families. I enjoy emergency medicine because I get to have a direct and immediate positive impact on the suffering of these children and their families.
I joined Childrens Hospital Los Angeles because...
Once I completed medical school and finished my fellowship, I knew that I would always want to work in a large children’s hospital that saw every type of childhood illness and injury. I also knew that I wanted to work in a place where I could be challenged both professionally and academically, and be able to conduct research . . . I wanted the whole package of medicine. When the opportunity arose for me to work here, I took it because of several things . . . the job that was offered was interesting to me, I was offered the ability to work with residents and teach, I work with a vulnerable population where I feel my contribution matters, and I can do research and collaborate with others who view medicine the way I do.
Coming to Childrens Hospital Los Angeles was an obvious choice for me because we take care of the sickest patients here. Granted, I could maintain my same level of passion for what I do and work as a general pediatrician or in another area of medicine, but I have always felt that my greatest contribution would be to take care of the sickest patients. That’s what my training prepared me for and that’s where I feel I can make the biggest difference. |
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What my job means...
My work contributes directly to the mission and goals of the hospital, as well as the goals of my field which are to provide the highest level of patient care. But, as the Division Head, I get to be a coach. The Division isn’t about me - it’s about all of the people who make up our Division. And, I get to be the person who helps each person find their strengths and strive for the very best from themselves. I tell everyone who works for me that “You should come to work happy, be engaged, and feel challenged. If you start to come to work without feeling this way, let’s talk about it and change it.” My job is to engage people on my team in a way that they are able to create their own success and happiness.
The other thing that I get to do is train the next generation of emergency physicians. This is pretty intense both for us and for the next generations of practitioners because we are bringing individuals into our division who are just beginning to learn about how to care for children and who may not be familiar with emergency care and saying “O.K., keep up with us because we expect a certain level of professional quality service and you need to learn fast.”
Patients rely upon me to...
The Emergency Department, in many ways, is the front door to the hospital. Although we treat many children who have fairly routine illnesses, we also treat many children who need cutting-edge medical care. In these cases, I function as the emissary for each of these patients who needs additional care, ensuring that the child receives the services and resources our hospital can provide in a timely manner. My division must communicate calmly, slowly, and compassionately with family members, and coordinate care quickly with other divisions who may need information quickly so that they can prepare for the arrival of a new patient.
I come to work every day because...
Like most of my colleagues in Emergency Medicine, I am an adrenaline junkie. In the Emergency Department, every day is a challenging day. Every day for me is unique, the patient population changes constantly, I never know who’s going to walk through the door – what I’m going to see – what treatments I’ll need to provide –that’s all a mystery for me every single day.
Staff look to me for...
We’ve won all sorts of awards in the Emergency Department and a portion of what has driven our performance is that I work hard to make sure that everyone is content with their position and that we all perform well together. The work we do needs to happen quickly and we need to work well together because, if we don’t, patient care will deteriorate. I'm sure other Divisions create a similar level of camaraderie as well, but we really do refer to ourselves as the “E.D. Family.”
I feel my greatest contribution is...
When I signed on as the Head of the Division of Emergency Medicine and Transport, the division was experiencing a substantial amount of turnover. Turnover is a really bad thing for patient care. For me, I feel my biggest accomplishment was to organize the division, and build a team that works extremely well together. I’m proud to say that we haven’t had a physician leave our Division in over 10 years, basically, from the time I took over. |
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Kids on the Run
Having a well organized division allows me to be involved in the community to prevent children from ever needing our emergency department’s services. I work hard to create a link between the community and our hospital by volunteering for media and community events that are designed to educate the community. In addition, one of my faculty helped spearhead an annual 5K Run and Health Fair that is designed to help increase community awareness regarding child safety and health and wellness for children. The event included an obstacle run for the youngest children and 20 different booths all designed to educate kids and their family members about staying healthy. This year, the event was held in Pasadena at the Rose Bowl. Currently, we are promoting Kids on the Run as a prototype that could be implemented across the country to link hospitals to their communities.
Dehydration Research
One of the things that I have dedicated a great deal of energy to is the study of the most efficient way of treating dehydration in children. Although dehydration claims the lives of around 500 children each year in the United States, it has a phenomenal impact on children worldwide, impacting 1.5-2 million children each year.
The standard treatment in the United States is to provide fluids via an intravenous (I.V.) line, but in many third-world countries, using I.V. lines is expensive and might not be the first course of treatment used. My research has focused on using naso-gastric hydration, passing a feeding tube through the nose directly into the stomach as an alternative way of introducing hydration into the body. This method had not been studied previously in the United States, but represents a great alternative for regions of the world that may not have the skill or ability to afford I.V.s for larger numbers of children suffering from dehydration. For me, this research is very important because it represents a much cheaper way to save lives of children and has the ability to make an impact worldwide (publication based on this research can be accessed by clicking here).
Pediatric Disaster Education & Training
Most people don’t want to think about children being involved in disasters. But the reality is that, if a disaster occurs, children will be the most vulnerable. So far, there hasn’t been a lot written on pediatric disaster education and training. As our hospital serves as a regional resource center for pediatric disaster resources and training, I have created the first written training manual on pediatric disaster preparedness. This 150-page manual is: 1) the most comprehensive disaster manual of its kind, 2) forming the basis of an online training course for healthcare professionals, and 3) serving as the core for a full-day, in-person seminar offered to regional hospitals.
Teenage Drinking and Driving
I was asked to play a role in the docudrama, "Every 15 Minutes.” This piece simulates what can happen when teens drive under the influence of alcohol. All of the people involved in the film play the roles that they fill in real life - the students featured are real students, the medical personnel are real, the people from the court are real. M role is in attempting to resuscitate and treat students who come to my emergency room after the crash.
Watch clip of Dr. Nager in "Every 15 Minutes"
This program is part of a 2-day high school program called “The Walking Dead.” During day 1, every 15 minutes through the day, a classmate is announced as having "died" from drinking and driving. At the end of the day, the students who have "died" are collected and spend the evening of the first day writing their goodbye speeches. The students' parents are also collected and asked to write obituaries for their teens. The next day, the entire school assembles to watch the documentary, hear students read their goodbye speeches, and parents read their children's obituaries.
These assemblies are very compelling. You can, literally, look around a high school auditorium during a Walking Dead assembly and see over 1,000 people crying and it has become one of the most compelling programs created to help students understand the seriousness of drinking and driving.
On-Hand Physician for High School Students
I volunteer regularly to accompany groups of high school seniors on a holocaust tour in which they visit five concentration camps in Poland and Israel for a week. Ultimately, there are groups from 40 different countries that join the tour which is accompanied by holocaust survivors. I have volunteered to be the traveling physician with this group and will accompany the group again in 2009. |
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IN THE MEDIA
Chapter Author:
Pediatric Emergency Medicine
Popular Journal Article Feature:
More on safety at
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