Solving patient puzzles in the ER

Dr. Brittany Nobilette has happily returned to her roots, coming full circle from the day she came into the world.

She was born at Sharp Grossmont Hospital and later rotated there as a medical student. Today, she is a doctor in its emergency department, and feels very much at home — with good reason.

“I had always dreamed of moving back to serve the community where I grew up,” says Dr. Nobilette. “I can actually see my dad’s house from our ambulance bay.”

She’s wanted to be a doctor for as long as she can remember and grew up next to the Wilburs, a pair of internal medicine doctors. They would be an early influence and unofficial guidance counselors — suggesting college courses and places to apply for medical school, and sharing stories of what it was like to be a doctor.

When Dr. Nobilette was 15, her 13-year-old sister Chloe had a traumatic brain injury while horseback riding. She was in the Rady Children’s Hospital ICU for 3 months, with Dr. Nobilette and her family camped outside.

“My family lived in the hospital parking lot in a couple of RVs that a local church was generous enough to let us borrow,” she recalls. While Chloe healed, Dr. Nobilette chatted up nurses, doctors and physical therapists, sharing her plans to become a doctor and marveling at what they did on a daily basis.

“No matter what was happening, they had it under control,” she remembers. “They could handle any situation.”

Being in the hospital atmosphere left a lasting impression and eventually, she chose emergency medicine as her career path.

“I love to fix things, and every patient is a puzzle to figure out,” she says. “It can be difficult not knowing exactly what is going on in the moment and we do not have the luxury of time. We are puzzle-solvers with a limited clock.”

Paul Larimore, manager of the emergency department at Sharp Grossmont, sees in Dr. Nobilette someone who went down the road meant just for them.

“Brittany is a high-performer in this fast-paced emergency department, and I can attest to working through many of these puzzles with her when there is no handbook or protocol to tell you what to do,” says Larimore. “She takes the time to assist her nursing and physician colleagues, and is a great doctor, patient advocate and a wonderful human being.”

Working as an ER doctor during COVID-19 has been a tough pill to swallow, but Dr. Nobilette chooses to call it a “blessing in disguise.”

“My chief resident taught me early in my career that you never know what is possible until there is no other option but to succeed,” she says.

Doctors seeing patients in every single ER pod and in the surge tent — all in one shift — has upped the need for better multitasking. Working in an environment where pivoting and fast thinking are routine has helped clinicians like Dr. Nobilette adapt to new ways of doing things.

“We’ve had to learn how to be more resourceful and more efficient — even going to meetings via video call frees up time you would have spent driving,” she says. She adds that teamwork and adaptability has been critical to the department’s success.

“We have new treatment spaces, new schedules, new equipment, new protocols, new social standards and new ways we have to communicate with patients and family members. New everything! But the good news is we are flexible, we are resilient and we can do hard things.”