Earlier in 2018 I was rotating through Anaesthesiology (Anaes). I really enjoyed this rotation which showed. While I spent the 5 weeks learning as much as I realistically could, I often thought about whether or not I could do the hours in the operating theatre, using drugs to control the conscious state of a patient. That wasn’t all Anaes was about, we learnt life saving techniques even went on to use them on patients.
I felt like Anaes was for me, the theory was interesting, the way we could manipulate drugs to ensure that life saving surgeries could happen, they’re the ones called when someone has a cardiopulmonary arrest, or someone cannot maintain their airway. Anaes controls the Intensive Care Unit (ICU), a place that I enjoyed. You had to be precise in ICU, you had to be precise in Anaes. I could do chest compressions, I could bag patients, I could do IV accesses and I could mix medication and calculate doses.
We have these things called procedure cards, it is filled with procedures we must either do or see under supervision. One of them was intubate. So it was my time to intubate, it was a small group of us since we weren’t in one of the Kingston hospitals, everyone was watching me and we were talking about it- maybe just a bit too loudly. I was nervous, and that did not inspire confidence in the patient.
It must be nerve-racking to be someones “guinea pig” or someones “first” anything. Most patients don’t want people trying things for the first time on them- much less a medical student. I am grateful to those who do let us try and do let us learn. I am forever grateful.
Anyway, back to the story. I had read and watched videos, and seen doctors intubate a number of times, so I was ready.
We worked as a group, someone else- I can’t remember who now- pre oxygenated the patient before we gave her the medications to make her both sleep and relax her airways. I remember this patient was nervous- but to be honest I don’t remember any patient that wasn’t nervous. Maybe they were afraid they would never wake up from the sleep, maybe they were afraid they’d be awake and feeling everything and we wouldn’t know (we would btw). I don’t know. I just know after a few surgical rotations, surgery and anaesthesia were all scary to me if I were on the receiving end. So I got it. We did our best as a team to calm the patients down, there are tactics used to have them relax while you push the medication otherwise the anxiety could pose a problem.
The patient was pre oxygenated and now she was asleep. In that moment my brain went blank and my hands were shaking. I was scared. It just occurred to me that I had to secure this persons airway, I was the next step between whether she would breathe or not. I was not calm. The room was like the arctic but I was in a cold sweat. I had never been this nervous in my life. I had done urethral catheterizations, given multiple injections, taken blood, given IV accesses, I had done CPR… there was so much I had already done. But I felt like I was the person standing between life and death and here I was with my hands trembling.
The consultant came by my side. She helped me visualise the airway and repositioned the patient, then made me do it then check. In the end I did intubate the patient, in the end I did remember how and I knew all the things I needed to check for. But knowing and doing are two different things, and while I didn’t actually forget my medical training, I got a clear understanding of what practicing medicine can be like. To this day I still fight about whether or not I’m proud of myself, I felt I could have done better and felt ashamed that I needed help and that my classmates could see I was visibly shaking. That I was scared. On the other hand, I didn’t give up, and got through even though I had help- which is exactly what the consultant was there for. I’m still not sure, and I think it’s because I had set high expectations for myself.
Aneas has continued to be a recurring interest area in my life, it introduced me to medical ethics first- a topic that I adore. No matter which speciality I’m in I’ve interacted with Anaes. That day I learnt several lessons, but most importantly I learnt that in high stress situations doctors must remain calm, we must always be on our toes and high alert. There have been many scary situations that I have seen and I watched with awe at how relaxed the doctors were. But the truth is, you have to be. You have to be calm that’s how you save a life. After the fact you can acknowledge how high stakes the situation was but not during. We cannot afford to psych ourselves out.
I’m still learning how to have that confidence, that confidence comes with both practice and knowledge. There are things I’m doing now that would make me nervous a few years ago but all that has changed is that I’ve practiced, I’ve become more knowledgeable and I’ve become more confident. When it comes to trying new things, I do so confidently, I’ve always been eager to try something I’ve never done before, and now that new approach of “I’m confident, I will get this but it’s okay if I don’t” has changed how many successful first time attempts I have had.
You know that saying, ‘measure twice and cut once’? This saying has been my motto when it comes to my life. Preparation is key. Even though this is a medical scenario; you can use it in your own life and experiences. The universal advice of “just stay calm” can be applied to any scenario, test taking, driving in an unfamiliar place or even trying out something new. Medical school might be preparing me for my career in medicine, but it has also taught me many life lessons I will never forget.
Samantha C. Johnson