Back in the, back in the…….

Back in the ER!

Yesterday morning I was back at the hospital. As I slipped into scrubs, stuffed my pockets with pens, scratch paper, and clinical guides, slung a stethoscope around my neck, donned the scuffy Danskos (at least, I *think* those are scuffs, I really do need to sanitize that situation….), grabbed a giant latte from the coffee hut and strode towards the ER, I felt myself relaxing and a giant, stupid grin forming on my face.

It hit me that even though I was relieved to be back in town after my last (really, unnecessarily) exciting interview trip, and I was glad to see my ratty little house, my pet children, and The Writer – I hadn’t truly felt like I was home until I was suited up and headed for the ER.

I LOVE rotating in the ER at my current clinical site. We get a fairly steady stream of diverse and challenging patients, but mostly I love it because pretty much everyone knows I’m nurse and they actually let me do stuff. I LOVE to actually get to do stuff. I am overjoyed to get to do anything and everything from starting IV’s, putting in Foleys, taking vitals, escorting patients to the faculties, getting a history, listening to breath sounds, or cleaning rooms. I don’t care how menial or non-high yield a task may seem to some (Because I have been questioned on this, “But are you actually learning Doctor Stuff when you do those things??”), I think it’s all valuable experience (Yes, even as a Doctor I think it will be important to know how to start an IV, put in a Foley, and yes, even know how and where to find my own supplies when there are no nurses or techs readily available to hold my…..erm, find them for me).

I realize that this probably isn’t the norm for many med students in the ER or on the Wards, and I read a line from a post on Nurse K’s blog recently that reaffirmed my assumption.

“People fluttering around, someone recording, doctor barking out crap to everyone….Med students standing around looking scared in the corner (as usual).”

Now I don’t think most med students stand in corner looking scared because they are lazy or because they don’t really want to participate, and recent events have proven that this really, probably is not the case.

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I was in the ER a couple of weeks ago and I happened to be on with a new (to me) RN who didn’t know my background and therefore assumed I was a run of the mill (intellectually impaired?) med student. We had several critical trauma patients come in right after shift change when there were relatively few staffers around. I went into the room to help. I looked around at what was going on, who was taking care of what, and heard someone yelling that they needed another IV site. I was all over it. I quickly grabbed supplies, put a tourniquet on the patient’s IV-free arm and started looking for a vein. There it was, a real beaut I could slide an 18 gauge into no problem.

Then, an inch and half from my left ear, I hear nurse new (to me)….

“HEY, MED STUDENT ARE YOU SURE YOU CAN GET THAT IN? ARE YOU *REALLY* COMFORTABLE DOING THAT? MED STUDENT, ARE YOU *REALLY* COMFORTABLE DOING THAT?????”

I tried to ignore them for an instant and just start the d*mn thing. I was hoping they might see that I did indeed appear to be at least moderately COMFORTABLE with what I was doing as I had managed to efficiently gather the correct the supplies and start the procedure, not to mention, there was literally like 500 other important things they could have been doing at that moment, and just maybe, they would they would leave me alone and go do one of them.

Nope. More frantic yelling in my ear.

In the second instant I thought, B*tch Be Cool. As much as I LOVE the doing stuff and taking care of business, I HATE it when medical people freak out in an emergency. Seriously. That is the opposite of our job, and when you are freaking out instead of doing your job, you are making things harder for everyone else. Especially, oh yeah, the patient who is not being cared for because you are too busy raising everyone else’s catecholamine levels. So take your own pulse and knock it off.

In the third instant, I decided that yes, I was perfectly comfortable starting the IV, but not while someone was hovering over me, literally yelling into my ear the entire time. It was in the patient’s best interest to step back. So after a few seconds I gave up, stood in the corner, and watched them struggle to implement trauma protocols short-handed.

When I thought about it afterwards, I understood where the nurse had been coming from (even if still didn’t think they should have gone completely cracker dog in the process). They didn’t know me or my skill set that well, and they were worried I was going to mess up and hurt the patient. Fine. Point taken.

I guess the thing that still bothers me is that, nursing background aside, I am a senior medical student and should know how to start a freaking IV, while you do other important things. Particularly if you could pause for one second and see that I look like I know what I’m doing. If I’m fumbling, sweating, dropping things, holding the Insyte like a javelin, using my own saliva to clean off the arm, or trying to start the IV on the patient’s big toe, Hey, by all means feel free to kick me back into the corner where I belong. And if I miss? Well then I’m sure you will manage to succeed where I’ve failed in .17 seconds flat, blindfolded, with one arm tied behind your back, while you maintain the patient’s airway with your left foot. I’m not saying a failed IV start attempt is the best case scenario, and it can waste precious time, but it happens, a lot, and patients still make it. Especially if no one’s freaking out.

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After this incident I decided to reevaluate my own assumptions about and interactions with other med students. There aren’t many med students at this clinical site and usually I tend to go about doing my own thing and let them do theirs. Which honestly, is often them sitting at the desk looking at their phone or a book, or holding up a wall somewhere.

So last week when another med student came into the ER and was about to take up residence at the desk, I beckoned them into a room to a see a patient with a big laceration. We took a history and evaluated the wound, and the attending came in asked me if I wanted to suture it.

Ummmmmmmmm, YEAH!!!

We went out to get supplies, and I stopped. I asked the OMS if they knew what supplies you normally need to gather to suture a laceration. No, no one had ever explained it to them. Well, here’s what you need……

We went in with the supplies and the OMS hesitantly asked if I minded if they watched. Okay, I really felt bad at that point. Of course not, I said. Get out of the corner and come over here where you can see what’s going on. I explained everything I was doing for the OMS and the patient’s benefit. When I was done the OMS helped me dress the wound and we gave the patient instructions for follow-up. I turned around to start cleaning the room and realized the OMS had gone back to the desk. I beckoned them back into the room. I said I know we don’t have to, but I like to help clean up the rooms and put supplies away. I guess I just like to keep busy, it really can help the staff, and it’s good to know where stuff is. The OMS had been rotating in the ER for the past four months but had never cleaned a room, had no idea where to put any supplies away, or where to find them. They were perfectly willing, but no one had offered to show them. I’m pretty sure they’ve mostly been hanging out in a corner.

I’m sure if I wasn’t a nurse I would spend a lot of time hanging out in a corner too. Because I would be afraid of messing something up, bothering someone, or God forbid, hurting a patient because I don’t know what I’m doing. I’m still afraid of those things. But I’ve been really, really lucky because as a nurse I’ve had amazing, patient, on-the-job teachers and co-workers who have always included and instructed me. This has given me the confidence to jump in, take advantage of learning opportunities, and to pester staff in med school until they teach and help me too. I think that’s a major difference between medical school and nursing. In nursing, you get thrown in and you learn as you go with your nursing teammates. In medical school, you do a lot of observing. Eventually, little by little, you get to do more, but your experience, and therefore your eventual skill, is highly dependent on the instructors and staff you work with and how much they are willing to include and teach you.

It’s not that med students don’t want to do stuff or participate, they’re just waiting for the right teachers and opportunities, and in the meantime, trying not to screw anything up, or get in a new (to me) nurse’s or doctor’s way.

When we go into medicine, we do it because we want to help people (okay I *hope* that’s why \:|) . Guess what, that apparently doesn’t just mean patients. It also means we have to help (not ignore, or really, yell in the ear of) the students, our future colleagues, who are training to help people too. At least, that’s the new assumption I’m working under. The next time you see a med student or a nursing student or a rad tech student, etc, etc cowering in a corner, I suggest you think about the kind of legacy you would like to leave in medicine, and you try it out too.

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2 thoughts on “Back in the, back in the…….

  1. What great insight, thanks for sharing! To add my own two cents I think med students also need to take some initiative and ask people how they can help. At my school we spend 2 weeks on the wards before starting classes as a first year and it was interesting to see how timid students can be. I’m not sure if it’s because I’m an older student who spent time working a “real” job, my strong personality or simply a combination of both but I sought out the students & residents on my experience who were willing to share their knowledge and helped with small tasks whenever possible. Including teaching a resident how to send a fax.

    Your ability to bridge the gap between nurses and med students is very unique and I hope OMS was grateful for the opportunity to learn! I also hope it will breed a “teamwork” approach in your ER. One can only dream, huh?

    • Thank you for the comment and your cents/sense Ally, much appreciated! 🙂

      I agree that it would behoove med students to jump in and many do, especially, in my experience, non-trads like us for some reason (most likely the reasons you mentioned). Many do not however, and as I alluded in the post I think it’s more out of fear of hurting someone/getting in the way/getting in trouble than purely not wanting to. Which are probably all legitimate concerns that could be alleviated if staff takes an active role in including and teaching students. Which many staff do. But, many do not, I think to their own detriment and to student’s.

      Personally, I think it is really fun to teach and actively learn as part of a team, and I think we all benefit more from this approach. Students learn more and become more skillfull, and practicing clinicians can keep skills sharper by teaching and getting all the latest information from students. And again, it can be REALLY fun. How great is it to love what you do and share that passion with another, hopefully inspiring greater enthusiasm and passion for the work of patient care in the next generation? I’ve heard people complain or even refuse to take students because it “slows” things down, but frankly, there’s always a way to make time to teach and work as a team. Frankly, I think its an unstated but inherent and important responsibility when working in medicine that we all need to embrace. We all ultimately benefit, and most importantly, so do patients.

      Personally, I can’t wait to teach, try to inspire future practitioners, and help with keeping up my knowledge base in the process. You seem to have the same excitement for the work and I have a feeling you are going to be inspiring the lucky generations of aspiring practitioners who get to work with you too!

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