To whom it may concern,
I would like to share with you my experiences in San Diego this past week. I was able to participate in “hyper-realistic” training for mass-casualty emergencies with 29 other medical students from two other schools. It was an experience that is difficult for me to put into words, and an attempt at fleshing out my thoughts is going to be a challenge. But hey, here’s to trying!
On day one, we were asked to write down what motivated us in medical school. And we were asked again on the last day. And I wrote down the following:
Day 1: “Success”
Day 6: “To save someone one day”
And that is a pretty accurate description of my week down in San Diego. I could stop here and leave it at that, but there’s so much depth to my training that I don’t want to short-change anyone and keep it for myself. Sure, I lost one week of “dedicated board prep” for our little adventure. But our experience was so much more than that. It was more of an existential journey, as cliche as that sounds, for my motivation in studying medicine. And to be honest, recently my motivation has been lacking, as one may tell with my simple half-hearted answer of “success” (which at the time, I thought was a pretty decent answer, because I wanted to prove myself — but that’s another story). So let me explain by putting you in my shoes for half of a day here.
Imagine for yourself, the following scenario:
You are the bright-eyed, bushy-tailed straight-out-of-medical-school Army physician who is relieving a colleague of a currently stable 45-year-old male patient who came in a few hours ago from a blast injury. Let’s face it — you haven’t experienced trauma before. The chaos around you is new to you, but it seems to have cooled down. The patient has two fractures: a left-humeral and left-femoral fracture. He lost 1L of blood which was replenished with 2U type-matched blood and 1L IV crystalloid fluids and was also given 2g Ceftriaxone IV. Xrays show complicated angular fractures of both extremities. He had a negative FAST exam and no head trauma. After the hand-off, you get to know the patient — his favorite movies, his recent trip to Baltimore — where hey! That’s where you’re from!… when all of a sudden he starts bleeding profusely from the loosened tourniquet on his lower leg and begins to have a massive seizure. You are the physician.
Before you can think, two other colleagues rush to jump on the bleeding leg tourniquet, compressing it with their knees and yanking the tourniquet tight. The patient’s seizing and it’s your job to stop it. You can’t remember the drug to give the patient. You’re freaking out. From past experiences, the only real-life seizures you’ve seen were managed with waiting it out. So that’s all you can think of doing. But your patient doesn’t stop. He’s foaming at the mouth. He’s shaking all over and blood is all over your hands.
He’s in status epilepticus.
You don’t know what to do. You can’t remember how to help this patient. Even though you’ve been taught, over and over, about Ativan.
“Ativan!” someone shouts at you, “give that patient some fucking Ativan!!!!” and your body’s running for you towards the medication cabinet.. But it’s not anywhere. “How much Ativan are you going to give??”, and you realize you can’t remember the dose. Wait, were we even taught what the dose was? And then you remember. You’re not a physician. You’re a second year medical student, playing the role as a physician. You don’t know. You can’t even find the make-believe vial labeled Ativan. You weren’t required to know based off your curriculum. In panic, you ask your fellow doctors, AKA other second year medical students, who are now trying to escort out the worried-onlookers who rushed into your ER. No one can help you. And your patient is seizing, frying his brain right in front of you. And it’s your fault you don’t know. The REAL Navy physician supervising you has such a disappointed look on his face that reads: your lack of knowledge is killing this man.
Your mind is blank.
“If you don’t know what to do, look it up!! You have a phone!!” the Navy physician finally yells at you. So you stumble for your phone. In your nervousness, you can’t type right. You keep typing “atrivab doxage”, or “attivam dpsagr”, until finally you get it right. You find it: 0.5 mg to 2 mg IV. You rush to your patient to administer 1mg IV Ativan, and they finally stop seizing. You order more tests — FAST exam, chest XRAY, non-contrast head CT…
And you finally breathe again.
This was the scenario I had on my last day at STOPs, and was by far the most motivating, and educational day for me there. “Success”? sure. But to me, I don’t care about proving myself anymore. One day I will be presented with a patient like him. In a real scenario, the knowledge I SHOULD have had may not come because of my lack of motivation to study all those years ago — which is right now. And that is why, my motivation for medical school has drastically changed. I am EXCITED to study for boards. The more I learn, the more deaths I can prevent from my own ignorance. There is no substitute in education for hands-on experience. That is what motivates you. At least that’s what now motivates me.
And as a last note: now I will never, ever forget to now give a seizing trauma patient a dose of Ativan (which, I was told later, should have been 2mg because it was such an emergency, hehe). As I said on my Facebook post, I am so grateful for this week’s experience. I can’t wait to get out on rotations and apply this knowledge to actually help people, and “to save someone one day”.
Theresa Price, OMSII
2LT, US Army, MC
Links to video footage below: