Just breath…
I am taking the time to write this out now while the thoughts are still fresh…even though I NEED to be studying. This will be my little break for the evening.
I think it is important to write this down for the future when I will need a reminder of why I want to become a doctor because tonight was a prime example of a moment in time that I needed to capture and will come back to someday.
Just to give a little background….It has been a tough few days-I am in the trial process of testing out different ways to learn. Some things work-giving me hope-while other things don’t- disappointing me. I joined the emergency club my first week of being on campus (paid my dues-therefore committing myself) and thought this would not only be a great setting to learn in, but also because I enjoy this stuff and see it as a time to relax and learn and simply have a good time with people of similar interests. Last week I signed up for the airway management class put on by the EM club tonight and even though I have so so so SO SO SO SO much to do….(trying to suppress freaking out right now)…I just had to go to the workshop.
And am I oh so glad that I went.
We started with the basics: inserting the OPA and NPAs while working with non-rebreathers, nasal canula and bag valve masks for basic oxygen supplementation. It was a little more of what the BLS session a few weeks ago taught us. This was all good information to know and it was all necessary to move onto the advanced airway portion of the evening….INTUBATION!! :) yahooooo!!!
I have seen many intubations while working in the ER over the past few years-some by physicians who make it look like the easiest procedure and others who have shown difficulty with tube placement or patient complication. I have written countless procedure notes entailing how a ETT procedure was performed on the pt and detailing the equipment used, steps performed and how sedating/paralyzing drugs were used. This was very helpful tonight in the workshop because I was already familiar with all the equipment and terminology.
However, no amount of observation, as good as it may be, teaches in a way that parallels actual practice and performance.
Tonight-I got to intubate! (A simulator -not a real person-but a fancy simulator mind you! :) )
I could not help but stand in the exam room and think-“this is awesome!” I have stood in these rooms for a cumulative of many hours over the past few years, but to be the person performing a very advanced procedure-now that lit the fire inside me! And boy, was it about time!
Sure, the wet lab (cadaver lab) is my favorite place to be as it is interesting and I am able to work in a tactile manner to learn the body—but these little sessions are great reminders as to what I am working towards-that being patient care.
Intubating someone is not easy and that is said after having intubated a perfectly assembled non-living patient under simulated conditions. Ha. I can just imagine the faces of my ER doctor mentors who intubate a variety of people on a daily basis…
I can only image the challenge I will face when the circumstances require fast, efficient and accurate work to save someone’s life. Having observed all the intubations in the ER, my eyes would always split their time being glued to the physician intubating along with the vitals, specifically the O2 sat monitor. I always knew that by the time someone required intubation, their breathing was severely compromised and you only have so much time to fix the problem-but the facilitator at the workshop tonight put it into perspective as to how little of time you actually have to get the procedure done. He told us to hold our breath for 30 seconds and tell yourself that that is the state of the pt-not able to breath-so the sooner you can breath, the sooner your patient can receive oxygen. This coupled with a new procedure and remembering the steps and working with a team of 2 or more others, makes for a moment that flies by.
At one point, I let go of the intubation tube and looked away form the trachea before completing the procedure and my facilitator got after me for doing that…rightfully so. It comes with the territory of doing something new that things are going to go wrong and I will feel embarrassed or confused. But-this is a LEARNING environment and any pride, embarrassment of confusion needs to be addressed quickly and should be replaced with knowledge and correction. Even if it means “asking stupid questions” which I really do not believe there is such a thing…or looking like the person who does not know a single thing-there will always be a point where I will be in an uneasy situation but then there will be those times where I remember my errors and know how to avoid making them again. So, I took a mental step back, reoriented and continued with my procedure followed by re-doing the procedure to put the correct method into my muscle memory. I figure that this is my opportunity to not just learn what I did wrong, but also do the correct thing so I remember how it feels to do it right.
I sometimes fail to put myself in the patient’s place and remember that they are enduring the worst possible situation and the physician (someday me) is the one who has to be skilled to resolve the problem. Isn’t this called empathy? When I remember this, I think to myself, “get it together Merissa. All you have to do is use common sense along with what you have learned and start thinking of your next move. You are in a better off place than the distressed patient is who is looking at you.” To be honest, that is a little scary-being the one who has to know all these things-but is that not an appropriate feeling given that I am only a one month old medical student? I hope this is normal. Ha. Oh my. Maybe I am getting a little ahead of myself.
Back to the session…
All in all, I learned a lot. I learned how to intubate someone and really enjoyed this.
On a side note…I remembered why I loved being in the ER and that feeling of not knowing what will happen next, but knowing that a decision must be made-even if it is an unnerving decision.
I was reminded that fear is contagious. It can flash across the face of someone in an instant but have lingering effects that change the entire environment of the team you’re working with. This was apparent not only tonight when we were being tested on how to intubate, but also throughout the week of my studies in regards to how I am studying and coping in general. This made me think of the times when some of the advisors or students I have talked with told me that at times my facial expressions give away exactly what I am feeling. For the most part, I am unaware of this. I do not want to be so controlled that I cannot be honest, but I also do not want to be so transparent that I instill doubt into someone as opposed to faith in my abilities or attitude. I am still trying to figure this out. I have always been drawn to the people who are calm, collected and communicative. Saying this, I think it is possible to convey that I am fearful in a calm and collective manner as long as I am clear that I NEED HELP. From my observations, this is the case in the ER. The ER doc must, MUST, have some fear inside them for the sick or injured patient for which they are caring…I could be wrong, but this is my current thought on the matter. And yet, all of the doctors that I enjoyed working with, rarely became flustered-or at least showed that they were flustered. They would show when they were not pleased or when things needed to be done hastily, but they did not become overtly anxious. I say this because I have to remind myself that if I let my thoughts, which can be rapidly racing at times, to fester, they will undoubtedly show and influence how I act and how others respond to me.
School is tough. There is no way to emphasize this more unless you are sitting across from me as I say this to you. Only then, will you see that fear flash across my face (and maybe even leak out of my eyes. ;-) … BUT, I need, NEED, need to keep the mindset that there is a difference between accepting struggle vs accepting defeat. I am not ready, nor planning to accept defeat…So, that is why I had to take the time to write this, because I KNOW that there will be times when I will struggle and feel defeated but need to remember what the goal is and keep that healthy perspective. I have already had a handful of those moments.
In conclusion, this week was tough- but tonight was great.
I have specific ER doctors in my mind all the time and always think back to specific moments where I wanted nothing more than to do what they did. Well… now I have the chance to gain those abilities-I finally have what I wanted for a really long time and do not want to give it up even though it is really really really hard.
Please pray for me.
-M.H-
One month old medical student
I have a place on the island that is where I can breath easy, study effectively, feel at rest and retreat to when needed at any time. I have my area that the people around know I come to often and even know my table-no one sits at my table! I feel home here… and that says a lot because I have always associated with a gypsy sort of mindset-I prefer to go to new places and never stay in one place…but given the circumstance, having found a place that is special to me in the midst of school, is nice. There are no people from the university here so I can take off my “blinders” that I wear on campus-you know the things draft horses wear that partially cover their eyes when they are walking with the carriage? Sometimes, I have to metaphorically put those on at school because it is easy to be influenced by other’s attitudes with school-in a negative way. I am learning how to have tougher skin and let things that really do not matter not penetrate my mind so easily. I think it would be accurate to say I am a resilient person in general-but I am in no way immune to chaos and challenge and subsequent struggle and negative thoughts. On a side note….the song on the radio: “bullet proof” just started playing…haha…good timing!
