I tripped into the patient's room
because I wasn't really watching where I was going.
I was too busy devouring the ACLS cheat sheet I'd made
for myself at the beginning of this cardiology rotation.
"Airway, breathing, circulation," I mumbled to myself.
"Pulse present, pulse absent..." Despite having memorized
the sequence numerous times, I still couldn't shake
the feeling that I might kill someone.
That was assuming he wasn't dead
to begin with, which was what my current patient looked
like. His thin parched lips collapsed into his cavernous
mouth, his blinking eyes were welcoming the light, and
his ashen skin, greasy but dry, yearned for the earth
to reclaim it.
"Who are you?" one of the nurses
asked as the others resumed their dance, turning up
the oxygen flow, connecting the patient to tubes, electrodes
and bags.
"I'm the cardiology resident,"
I said as confidently as I could.
"Oh, you'll do," replied the nurse,
matter-of-factly, and carried on setting up the monitor.
In stark contrast to the ACLS course,
I actually didn't have to do anything as the scene unfolded
automatically. Equipment was being set up and people
organized themselves as if they knew what they were
doing. They trained me to be the code leader, to call
the shots and take charge, but in the CCU, I was the
lowest common denominator as the nurses did this every
day.
"He's in asystole," the nurse said.
"We double checked the leads and turned up the voltage.
What do you want to do?"
She was entertaining the idea of
me as a doctor. I wanted to shout Give me the paddles
and stand clear! but I didn't want to lose all credibility,
so I said "Start CPR." This was real life and not television,
although admittedly there were times when I felt like
I was merely playing the role of a doctor.
"Do you want epi?" she prompted.
"Let's give one milligram, and
one of atropine," I said, feeling like the weak partner
in a musical duet.
TRUST
DEFICIT
Part of the frustration about working in a CCU as a
junior resident is that I lacked autonomy to make my
own decisions. I would get paged with a problem and
if the nurses didn't like my answer, they would ask
me to page the cardiology fellow. They don't trust the
junior residents, perhaps rightfully so, but it definitely
added a unique dimension and challenge to the work environment.
The flip side to this is that I
knew that the patient in front of me was in good hands.
The nurses will back me up, cueing me on things that
I've missed or reassuring me that I was on the right
track by carrying out orders without questioning them.
Within minutes, the cardiology
fellow came on the scene and pushed me aside. The senior
medicine resident (who was matched to cardiology) also
arrived along with ICU residents, medical students and
staff, so I guess it might have been a good thing that
I didn't have to perform in front of this audience.
In this quasi-structured learning
environment, I take something away from every experience
and the worst thing that can happen I think, is if I
hid from these challenges.
Even knowing this, every time a
code is called, my mind has to force my legs going in
the right direction, while every fibre in my body tells
me to run the other way.
|
