THE Experience

This is going to be somewhat of a long post. Just thought you ought to know.

I know nothing.

My classmates and I have been told numerous times about this certain experience. I have read about it in different books as well. However, no matter how many times you are told about this type of experience, you can never (EVER!) be prepared for it. You just recognize it while it is happening and realize that all you can do is learn from it.

I felt utterly, completely, and universally inadequate today. I mean jaw-dropped-on-floor, want to cry and run home inadequate.

I will give you the general version of this experience followed with a specific description of what I wen through if you want to know the medical details. I will deviate from my normal way of writing and not create links for every medical term, it would take too long. If you really want to know, Wikipedia is there to help.

General Description:
I knew that at some point, all of my book-learned knowledge would be useless. It would go into hiding behind some lead-lined wall in my head right when I needed it. I was told that I would be put into some emergency situation and two things would happen: the first was that I wouldn't realize it was an emergency situation and the second was that I wouldn't know how to react (thanks to that lead-lined wall). This is what happened today. I walked into a patient's room with a doctor, the doctor realized that the patient was not doing well at all (READ: If we had walked in about 10 minutes later, we would have had a scene from ER running at the hospital). To my credit, I would have realized the same thing, only about 30 seconds later. The doctor began firing off orders in a completely calm and orderly fashion, while I stood on the sidelines trying to be useful by not getting in anyones way.

What a way to learn.

Specific Description:
At about 7:30 this morning, I was pre-rounding on a patient. This patient was morbidly obese (weighed about 170 kg - kilos people, not pounds) and had a history of: aortic stenosis, COPD, CHF, diabetes, and electrolyte abnormalities. Basically, she was not a "simple" patient by any means. I spoke with this patient for about 45 minutes, and she was mostly fine (as fine as can be expected) at that point. She was able to hold a conversation with me and coherently answer all of my questions. In fact, she had even been mad at me for waking her up and asking her a bunch of "stupid" questions. To move the story along, I did the physical exam and got her history. Out of all of the things that were wrong with her, there was one that didn't fit: her respiratory rate was somewhere around 30 per minute. Most physicians really wouldn't like this number. I understood it to be high, but I didn't realize that it was high enough to set off alarm bells. When I was presenting this case to an attending it was about 1.5 hours after I had interviewed her. After I mentioned the little tidbit about the respiratory rate, I was peppered with more questions and we decided to see the patient.

When we walked into the room, the patient looked sleepy. "No big deal," I thought, "She was like this earlier." Oi. The no-big-deal part didn't last that long. After trying to wake her up by saying hello, and her not really responding, the attending determined that she was crashing. (Enter the part where I hopefully would have realized that she was crashing about 30 seconds later if I had found her on my own.) After that, there was a flurry of action. The attending set a trillion things into action: and ABG was ordered, stat xray, stat EKG, 40mg of lasix, 2mcg of morphine, 125 (I forgot the units) of methylprednisolone, respiratory treatment, and stat labs.

And what was my job?

Attending: Stay here and watch what they do.

Me: Okay.

I did my job really, really well.

I had this horrible sense of helplessness and inadequacy. It is almost like watching someone die that you know and realizing that you almost know how to save them, but you can't pull that information to the front of your brain.

If I had discovered her by myself, the situation would have been different. I would have realized a little bit later something was wrong, then I would have either yelled for help for went to get the attending, and then the same scene would have played out.

Now that I have had a chance to think about all of this stuff, I realize that I am not completely useless. I understood all of the life-threatening things that could have been causing her shortness of breath. I just didn't know what to do acutely for them.

Medicine is a scary thing people! The nurse for that patient had just seen her 30 MINUTES before all of this had happened and she had been just fine. That is insane! 30 freaking minutes went by and this patient's body went from 'dealing with the problem' to 'f*** it, I don't care.' This was a shocking experience for me. I seriously called Mike after it was all done almost crying. I was just so moved by the whole experience.

I must try to get as much experience in anything that I can. I just feel so inadequate.

And to make my day even more interesting, I saw a sex offender today as a patient. I was instructed to leave the exam room door barely open, just in case.

Wow, talk about an interesting day.