In this edition of EMPower, we are seeking to learn from Dr. Angela Fiege, a critical care specialist, nonprofit founder, and medical director on the Indycar race circuit.
When I did an elective rotation at IU Health last year, I was pleased to meet Dr. Fiege and have the distinct pleasure to work with and learn from her throughout the month. I was happy to receive an email recommending that I interview her for this publication! Though I learned a lot about her over the course of the month from her accomplishments on race tracks around the country, I was excited to learn more about her work with the non-profit she created and highlight it for others who are interested in learning more, sharing the work, and possibly doing similar work in their careers.
Dr. Fiege holds many titles in addition to Critical Care and Emergency Medicine physician at IU Health Methodist. She is the Medical Director for the Indy NXT series and deputy medical director for the NTT Indycar series, a track physician for the Indianapolis Motor Speedway, and founder of the nonprofit Rachael’s First Week. She serves as a nocturnist/critical care specialist at IU Methodist Hospital, where she cares for the sickest of the sick. She has worked as a track physician at the Indianapolis Motor Speedway since 2007. In the past, she has served as the Medical Director for the NASCAR / AMR Track Safety Team traveling weekends to NASCAR races across the country. Yet if you ask Dr. Fiege what her greatest accomplishment is, she will tell you it is founding Rachael's First Week, a nonprofit organization she created as a legacy to her late daughter, Rachael.
First things first, why emergency medicine?
I think most people choose EM for the breadth; you get a little bit of everything. Because I started out as a flight nurse, I had EM in my blood already. There is always an adrenaline kick, but the speed at which you have to operate and the flexibility is quite fun. I couldn’t see myself doing anything else. My critical care is very “emergency medicine” in style. It is the perfect blend when I’m taking care of high-acuity patients.
If you were restarting residency, what advice would you give yourself?
Spend more time investigating the gaps in your learning. When you come onto shift, it’s oftentimes that you’re working as hard and fast as you can. Residency training is a great chance to be mentored and to do that self-introspection before you take on that role as an attending. It’s important to work to find that balance between patient care and education. Use case-based learning when you can as well, because not everyone will have the same experience in residency and the same patient opportunities.
What is your greatest accomplishment?
My daughter’s legacy. Without a doubt.
Tell me about Rachael’s First Week. How did you get the idea to start this?
Rachael went to Indiana University. I had just finished a night shift when I got a phone call from the hospital that she was there. I couldn’t fathom why she’d be in the emergency department, so I asked if she was on a ventilator, and they said yes. I got in my car and started driving. When I got to her bedside, I lifted up her eyelids, and I saw that her pupils were fixed and dilated. I knew at that time that her prognosis was poor. She had gone to an off-campus party with some people she knew. She fell down a flight of stairs. There was alcohol involved, and she was staggering around, so they brought her up to lay on the couch. When they checked on her later, she wasn’t breathing, so they called EMS. She arrested a few times before they could get her to hold a blood pressure. They called me at that point. It was a complete life changing experience, which led to me reevaluating everything in my life. I’ve been to pretty much every hospital in Indiana. It was the beginning of the college time period, and it became newsworthy. If you knew my daughter, the kind of person she was was always taking care of the less fortunate. She was very giving, and I wanted to honor the kind of person she was. I kept thinking about that, and I came up with the idea for an educational program. The other people at the party meant well; they just didn’t know any better. The idea is for nonjudgemental learning points. It has grown from teaching at high schools all over. The entire residency class at IU came to the first one. We used the Youth Risk Surveillance Survey to come up with the curriculum.
Tell me about the impact you’ve seen Rachael’s First Week have in the community.
We’ve talked to most of the colleges in Indiana, the freshman classes, and sororities and fraternities. We also talk to high schools at the end of their years before they graduate. The topics include the Indiana Lifeline law (amnesty law for students who call on behalf of another student if the user has alcohol involved), alcohol, stimulants, THC, sexual assault, mental health, and creating a new culture of looking out for each other. You’re not with your parents anymore or anyone who will rescue you. It’s about being a responsible human being. We use poll everywhere, and we compile the data for school counselors to have a pulse of what is going on with their students. We have two podcasts as well: SafeTea and Three College Idiots. It’s hard to quantify prevention, but over 20,000 people have been spoken to about this topic. It’s not infrequent to get a letter from a student or a parent, saying that something happened to them and that they remembered Rachael’s story and called 911.
What do you think EM residents can learn from Rachael’s story?
Find your passion. I would hate that anyone else would have to go through what I did to find their passion. If you chose this specialty, more than likely, you have a heart for advocacy. We’re seeing every patient has a need, so find your niche, and try to make a difference. It doesn’t have to be a huge project; the small projects also make a huge impact.
How has your daughter’s story changed your practice?
I think it taught me how to talk to families and concerned others during the bleakest moments of their life. Sharing bad news is very important and very hard. I think having gone through that experience has made me more in tune to what people are going through in times of stress and how to support them. I’ve seen the whole spectrum of response, and I would not be the kind of physician I am without this experience. Showing people grace at a bad time in their life is very comforting during their suffering.
What is your best time management tip?
Sleep. One word. I’ve been a night shifter for so long. You can’t remember things or maintain a schedule when you are exhausted. Maximize your sleep, because residency is grueling.
What is the best on-shift snack?
Whatever the staff have prepared for the patients! Be lucky if you can eat and pee on some shifts.
What is the most recent book you read?
Playing in Traffic, about the Indycar Flagstand Start, who has autism. It covers how he went from feeling awkward as a child to overcoming adversity.
What is your favorite song to hype you up before a shift?
I love listening to podcasts moreso, like Crime Junkie.
Do you have an idea for someone you want to hear and learn from on EMPower? Please let us know, at emresident@emra.org.