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The first time I worked in the OR way back in first year, the biggest adjustment I had to make was to get used to the masks. They're not very comfortable things to wear, fogging up glasses and making you rebreathe the warm humid air you just exhaled, generally making an excellent nuisance. They also prevented me from hearing people properly. I didn't realize how much I relied on lip reading to help me when people aren't speaking loud enough to be heard above the sounds of bonesaws and suction. The surgeon I worked with was a big Nigerian man with an odd accent, and without the benefit of watching him speak, I couldn't make out a single word he said.
Of course, with time, I learned to understand his accent eventually arriving at the point where I wondered how I ever could have had trouble understanding him. After a little while, I also began to learn to understand the mask.
Doctors pride themselves on a lot of things, one of which I'm sure is being funny. This, however, is not the case (see Stitches, the medical "humor" magazine. Any sentence, any picture, any page, any issue EVER. I challenge you to find an iota of funny in there. Stop sending articles.) Lots of lame jokes are cracked, some of which I just don't feel like faking laughter at. Hiding behind a mask, I don't have to smile. All I have to do is squint my eyes like I'm smiling and everyone thinks I enjoyed hearing the one about cheetahs never winning races. In secret though, my squinting eyes really say "I loathe your joking. Stop contributing to Stitches."
God that magazine is terrible. It's like Family Circus for doctors.
Another important aspect of the mask is that you can stuff it full of tasty smelling things. That way, when that tireyard employee who vomited up feces mixed with his last meal of burnt hair shows up in the OR, you can smell Calvin Klein's Obsession, rosemary and thyme, or whatever. Me, I soak it in Cheetos crumbs. That way I can also have a snack without anyone knowing if I get hungry, in addition to smelling hydrogenated oil, natural and artifical flavors, and coloring additive #43 all day.
The most useful part of masks is the emotional one I don when I meet patients. I do listen a lot, and try to stay attentive to their issues and problems. At the end of the day though, I have to go home and deal with my own life. I don't know how I'd do it with all the baggage I'd accumulate if I didn't maintain some kind of barrier between me and the patient. Really, I'm surprised psychiatrists don't go home and almost kill themselves everyday. Whatever Patch Adams said was a wad of garbage. Staying emotionally detached isn't something I do because I'll make better decisions for the patient. I stay emotionally detached because I'll go crazy otherwise. Crazy enough to start submitting articles to Stitches.
Every Friday during this emerg elective, I'm supposed to go to resuscitation rounds. Unfortunately, every Friday thus far I've been so eager to watch my new downloaded sepisode of "The Office" and "Scrubs" and "Andy Barker Private Investigator", I've forgotten to go to all of the rounds. This Friday though, I remembered.
Resuscitation rounds consist of going through different scenarios we might encounter in practice where the patient is in need of serious and timely medical care. The patient is a plastic mannequin who blinks, breathes, and has detectable pulses. Just like a real person! Also, he also has about 9-10 extra nipples made of brass to attach electrodes to. I think they're not made to be nipples though, just to look like them.
The best part about the mannequin is that he can talk. Everybody else seemed to think this was nothing out of the ordinary. I was amazed! It could hear your questions, interpret your words and respond appropriately! Just like a real person!
He even coughed and hacked when he had chest pain, and when he was defibrillated he screamed! Just like a real person!
I turned to one of my classmates and said "That mannequin is just like a real person!". Bemused, he said "Yeah... that guy controlling him behind the one way glass sure is good."
Oh.
So we spent the next couple of hours going through scenarios, each one of us rotating through the role of team leader. Because I'd missed all the previous sessions, I had no idea what to do as leader. Nuts to those NBC Thursday nights! Why do they have to be so distractingly entertaining!
It didn't help that the preceptor told us that the scenario was going to be really tough, to finish off the session. I was becoming more and more anxious as the start drew close. Suddenly, I remembed that it was only a drill. Stupid mannequin! He's not even alive! He should be glad he's getting any medical care at all!
Pulseless electrical activity. Ahhhh... I studied this several weeks ago, and of course I'd forgotten the list of things that could cause it. And I had never studied the proper intervention. My mind raced through possible treatments, or at least temporizers but nothing seemed to work. As soon as I'd tried one thing to correct problem A, problem B would surface while problem A was just getting worse. Wash, rinse, repeat.
So the patient died, and I was surprised at how crappy I felt. Nobody really died. Nobody's family has to listen to bad news. Strangely enough, I felt really guilty. I hadn't studied enough, and I hadn't been ready. I guess that mannequin's even more realistic than I thought. Just like a real person...
Ever since I was a kid, I can remember being told not to run. Don't run on the pool deck. Don't run in the library. Don't run when the building is on fire. In a society where running is forbidden even when your surroundings have exploded into flame, it becomes a pretty special occasion when you're supposed to run in a hospital.
So when there was a code on the psych floor and nobody was around to take care of the patient except for emerg, I ran faster than Forrest Gump on EPO. In a way, I was getting back at all the lifeguards, librarians, and old ladies with walkers I'd bowled over while escaping a burning building who have admonished me throughout my life for running.
I beat the crash cart to the elevator. I beat the gurney to the elevator. I even beat the trio of beefy/fatty security guards who were supposed to be there first to get the elevator down to the first floor. I don't think anybody else knew it was a race, but that didn't stop me from trying to beat them all.
The beating hearts were almost audible in the elevator. I could tell everybody was mentally going over what they were going to do when they got to the scene. Mouths moving silently, ticking lists off fingers, eyes towards the ceiling. Psh. That's such a loser mentality. I was stretching my quads and taking my mark for the next heat.
I lost in the final to the nurse with the teddy bears on her nametag. To her credit, she ran a good race, elbows askew to prevent any potential drafters from taking poll position on the inside lane. Maybe next time.
When I got there, and I'd had my fun, I felt a little out of place. There was a guy lying on the ground and everybody had crowded around him and the crash cart, leaving me out of the picture. I was now presented with a dilemma I'd run into a number of times thus far as a clerk; do I stand back and learn little, or do I squeeze in, try to get involved, learn more but possibly compromise patient care?
The phrase teaching hospital had always confused me, as everybody spoke of teaching hospitals as if they were excellent places to recieve care. But if I had the choice, I think I'd rather be treated in a community hospital. Not a tiny hospital, but definitely a place that isn't crawling with clerks eager to learn at my expense. On the other side of the fence, I need to learn how to deal with these kinds of situations.
So I propose the following. If you don't wish to have your care compromised by me trying to learn, send me an email with your name, social insurance number, and bank PIN and I promise I'll leave you alone. Otherwise...
Some sound better with exclamation marks!
Incarcerated bowel.
Pea-picker's disease.
Explosive diarrhea.
Megacolon.
General Paresis of the Insane.
Monoclonal Gammopathy of Uncertain Significance.
Organizing Pneumonia.
Beer Drinker's Potomania.
Vaginal Vault.
