Tuesday, June 20, 2017

How to be Good

“Make me good God. Make me good. But not yet.” – Nurse Jackie

The literal dividing line between anesthesia and surgery is a rather thin, sterile paper, blue drape. Anesthesiologists have kind of a thing about it actually. Everyone likes to secure the drape differently. I swear as long as I live, I'll never do it right. Even the most laid back resident has redone my perfectly secure drape. The art of drape folding is shockingly not something taught in medical school, so the first time I clamped down on the IV pole, cracking the plastic clamp and sending pieces of it flying precariously near the surgical field.

I’ve never seen that one before,” the resident said, quickly fixing my mistake-- and never trusting me with his sacred drape again.

Starting IVs is another thing they let the med student struggle with. The very first time an attending suggested I start one, my hands were shaking so badly I couldn’t even grab the needle from the drawer. He took one look at me, and then kindly suggested we "do this one together." Even when I did manage to get to the stage where you poke the skin, I was missing almost every one. Even in the SIM session we did. Every single stick on those stupid unrealistic plastic mannequin arms I was missing. They bleed food coloring for Christ sake. After a while even the saint like patience of the resident I was working with was growing thin.

You’re not looking at the catheter,” he said grabbing it out of my hands. 

I am looking,” I say back rather annoyed.

Not you’re not,” he insists, "watch me," he says sliding the needle effortlessly into a vein. 

We would do well to be a little more real about the learning curve regarding practical skills—especially cynical, impatient little busybody me. I don’t know how to fill a syringe with propofol without spilling it all over the place.  But because I spilled it, I now know how not to. You get good by being bad. How unfair.

Struggling and messing up is where the learning happens. Its important to try to run into situations where struggle might be possible, instead of avoiding them. For example, I tried every IV I had the opportunity to. And I missed a lot of them. But I am getting better. Well…at least I can grab the needle out of the cart…and I call that progress.

Intubation is another one of those skills that's semi-important on the patient’s not dying front. It can be tough, because getting the feel of the blade, the tongue, knowing what it is you’re supposed to see—that takes practice and it takes struggle. During one such attempt I looked up at the resident with those big “help me I’m stuck” eyes. “I’m just going to let you struggle,” he said like he had read my mind. Ugh. And struggle I have. 

I have found a million things I’m terrible at doing. A million more ways to mess stuff up. Umpteen questions I cannot answer, words that I do not understand. My facial expressions as of late alternate between raised eyebrows, nodding and my personal favorite—the blank stare.

But the more I try, the luckier I get. The days where I get both the IV and the intubation have increased in number. And that makes me feel good. And then the thought creeps into my head that maybe I’m actually good at this. Maybe I can actually master the art of drape clamping. And just when my step has a little swagger to it, the resident asks me to grab the IV for her. I pull the bag off of the tubing and am promptly doused from head to toe in a liter of saline. 


“Make me good God. Make me good. But not yet.”


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