Runway to Resuscitation: Knowing When to Support, Adapt and Lead

By Andrew Medeiros, PA-C, Assistant Professor, Public Health and Community Medicine

As part of our three-part faculty op-ed series celebrating PA Week 2026, Tufts PA faculty share their perspectives on the profession, the future of healthcare and the impact PAs can make in the lives of their patients.

In The Devil Wears Prada, Stanley Tucci masterfully portrays Nigel, the flamboyant creative director who navigates the fashion world like a bull shark with the scent of blood. He has wit, bravado, and a genuine passion for his craft. He takes the new girl, Andy Sachs, under his wing, guiding her as she is thrust into a world of intense pressure and, at times, unforgiving colleagues.

In one scene, however, he departs from his mother-hen instincts and challenges Andy’s “woe is me” attitude. “Wake up, six,” Nigel quips as Andy gripes about her boss’s seemingly impossible expectations. He reminds her that their magazine only makes it to print because of the dedication of many people, each contributing something essential. It is an important lesson: Though the work may be emotional and strenuous, for the Runway reader, the final product could be life-changing.

Nigel’s role is vastly different from mine, but as a physician assistant (PA) working in cardiac surgery, I recognize the same commitment in my colleagues. We hold each other accountable, lift each other up, and do everything in our power to heal patients during some of the scariest moments of their lives.

At Tufts Medical Center, our team of cardiac surgery PAs supports patients and their loved ones from referral through recovery. We take histories, perform physical exams, assist in the operating room, and manage patients throughout their recovery in the intensive care unit and step-down ward. Along the way, we work alongside cardiac nurses, respiratory therapists, pharmacists, intensivists, anesthesiologists, ECMO specialists, surgeons, and many others.

In a fast-paced, technologically intensive, and medically complex specialty, no single person can provide everything a patient needs. It takes many devoted minds, each bringing different expertise to the bedside. Communication is the backbone of how we function effectively. Concepts such as shared decision-making, mutual accountability, and closed-loop communication become especially vital during moments when a patient’s life is imminently at risk.

Recently, a patient on our service suffered a cardiac arrest while recovering from a heart transplant in the ICU. His transplant had been performed only a few days earlier, and until then, he had been progressing well: requiring less supplemental oxygen, working with physical therapy, and needing less medication to support his new heart. As in many cardiac arrests, it was not entirely clear what led to the event, but my colleagues reacted exactly as they were trained. A Code Blue was called, CPR was initiated, and the extracorporeal membrane oxygenation (ECMO) team was mobilized. 

In the aftermath, I spoke with PA colleagues who had never participated in extracorporeal CPR (eCPR) or managed a cardiac arrest of this complexity. They described uncertainty, grief, and even a sense of failure. They worried that they had not performed at the level expected of them. With an intensivist leading the resuscitation, nurses performing compressions and defibrillation, and respiratory therapists managing the airway, they wondered: Where was I supposed to fit in?

I empathized, as I have questioned my utility in those moments and still do seven years into my career. 

But our conversation reminded me of one of the strengths of the PA profession. We are educated in the medical model, trained to care for patients across a broad spectrum of disease, and taught to be adaptable. In cardiac surgery, that adaptability allows us to learn from the expertise of everyone around us while developing the knowledge and skills to step into whatever role the patient and team requires.

During a cardiac arrest, an intensivist may be leading the code, but the PA can track the medications being administered, verify dosing and indications, and anticipate what may be needed next. While others perform chest compressions, the PA can assess their quality and coordinate pulse checks. When defibrillation is required, the PA can ensure colleagues are safe by shouting “clear”. The PA can communicate with the surgeon, prepare for emergent procedures, synthesize what is happening across the room, and recognize details that might otherwise slip through the cracks.

Effective team-based care is not about determining who is most important. It is about understanding what the patient needs and recognizing who is best positioned to provide it. That role can change quickly. One day, the PA may be supporting a resuscitation led by an intensivist. On another, that same PA may be the clinician at the bedside with the experience necessary to recognize a surgical emergency, mobilize the team, and prepare for an emergent resternotomy. Being a PA means becoming comfortable with both realities: knowing when to support and knowing when to lead.

Nigel may not be Runway’s editor-in-chief, but no one can deny his aptitude, his drive for excellence, or the wisdom he offers those around him. He reminds Andy not only of the importance of her work, but of her own potential.

Being a PA is not always about the loud and chaotic Code Blue. Much of healing happens in quieter moments: explaining a frightening diagnosis, noticing a subtle change in a patient’s condition, answering a family’s question, or helping a colleague through a difficult day. PAs may not always be the most visible person in the room, but visibility is not what defines our value. Our strength lies in our versatility: our ability to collaborate, to adapt, to support, and, when the moment demands it, to lead.

Perhaps we all need a Nigel from time to time—someone who reminds us why our work matters and what we are capable of. As PAs, we should strive to be that person for one another. Our profession demands clinical excellence, but it also depends on fellowship, humility, a shoulder to cry on, and teammates who can still make us laugh when times get tough. Ultimately, that is what team-based care asks of all of us: bring your expertise, trust the expertise of those around you, and never lose sight of the patient at the center of it all.

Author Bio: 

Andrew Medeiros, PA-C, is a Boston native and Tufts PA Program Alumni. He works in Cardiac Surgery at Tufts Medical Center and teaches Critical Care at the Tufts PA Program. He loves skiing, hiking, traveling, music festivals, and spending time with his boyfriend, Darren, and golden retriever, Moose. 
 

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