Twenty-Seconds

I had always been eager to learn, but it was surprising to see how often I shirked learning opportunities out of fear of being bothersome or judged as incompetent. Medicine had muted me.

In the operating room, I had grown accustomed to being invisible. I had heard my share of horror stories. While my existence in the room was ignored, at least it wasn’t looked down upon. Naturally, I latched onto any person that was willing to teach me. Regardless of how small the task, I wanted to do it.

So, when your chief resident asks if you’ve ever put in a foley catheter before, you jump at the idea of “actively participating in patient care.” It wasn’t exactly a glamorous task or even remotely crucial to this patient’s surgery. The patient was here for an I&D to rule out necrotizing fasciitis, a flesh-eating skin infection, I’m sure you’ve heard of it. In addition, it was a red line case, a strategic slip many surgeons used to ensure OR time before the workday was over. Even with the circumstances, my chief still gave me the opportunity to learn. With the circulating nurse, I prepared the kit and started the process.

Meanwhile, the anesthesia resident behind the curtain circled the table and approached the computer station across the room where my team was waiting. “Isn’t this a red line case?” I heard him whisper. “Why are you letting the medical student put in the foley?” I froze. The disdain was almost tangible. A sense of panic grew as I tried to ignore him and finish the task.

“This is a teaching institution. If you had a student, I wouldn’t say that they couldn’t put in an IV. We can afford the extra twenty seconds for her to learn,” my chief responded.

I don’t know why, but all I felt was shame and embarrassment as he circled back to the head of the bed. Clearly, I was no longer welcome in the room. Not only did I not belong, but I had caused an awkward division between care providers.

Should I have spoken up for myself? Should I have apologized to the anesthesia resident? Maybe this wasn’t an appropriate time for teaching. The hierarchy never felt so concrete. Stuck in my own head, somehow I had missed the entire case. Physically present, mentally absent, just like my grade school teacher had scolded me years ago.

I stood by the patient’s side as he was extubated, ready to transfer him to the gurney for transport. At least this was a job I could do, while everyone else was preoccupied with placing orders, reversing sedation, and notifying the family. Suddenly, his plump red neck started to turn blue. The color crept upward, turning to purple and filling his cheeks. This wasn’t right, was it? No one else was worried, so I stood there, choking on my words. That’s when the beeping slowed.

The anesthesia resident turned toward the patient and chaos ensued. The oxygen sat’s continued to decline with a non-rebreather. His jaw wouldn’t give despite the full force the resident used to pry it open for an oral airway. Beep... beep.…… beep………… My attending and resident returned and by this point, 30% flashed on the monitor and a junctional rhythm appeared. Code blue, OR 12. Code blue, OR 12. The anesthesia attending rushed into the room, calling for everything necessary for a re-intubation. Within seconds he re-established an airway as about a dozen more people flooded the room.

The indigo faded away. The pink returned to his cheeks. In the silence, I heard a sigh of relief behind me.

Why didn’t I say something to the resident earlier? I let my fear of him stifle my regard for human life. I was too soft, too selfish, too weighed down to overcome my own doubt. Would I have spoken up if the case had gone differently? Was I just not cut out for this? If I couldn’t stand up for myself, how could I expect to be an advocate for my patient?

Maybe this was all unavoidable. Maybe it wasn’t. Time to desaturation is as quick as 2.72 minutes in the morbidly obese, less than half the expected time compared to a normal weight patient. Twenty seconds. Would it have made a difference?  

Reference:

Sirian R, Wills J. Physiology of apnoea and the benefits of preoxygenation. Continuing Education in Anaesthesia Critical Care & Pain, 2009 Aug; 9(4):105–108. https://doi.org/10.1093/bjaceaccp/mkp018

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Karen'’ s Bio is below keep scroling

Karen O’Laco

Current 4th year medical student. Future EM Physician