We three emergency interns sat there, chuckling to ourselves. We were to be a team, tested on Advanced Cardiac Life Suppport together, and our group was a good one. We knew our algorithms and drug doses backward and forward.
The day had gone well so far; all 14 of us rowdy ER folks had been identified right off the bat by the nurses running the course, who laughed, "You all must be the emergency docs. Every year, we can always spot the emergency docs." Too loud, having far too much fun for an ACLS course, rambunctious. Fun.
The group before us - 2 OB/GYNs and a GP - shamble out of the testing center. They had failed, and had to repeat the simulation. This was happening to a disturbingly large percentage of the groups leaving the sim labs. Not us. We knew our shit. Too cocky.
The three of us were ushered into the room. The scenario: Mr. Jones, a 56 year old male, presents to the Emergency Department for shortness of breath and chest pain. Cookie cutter ED stuff, but we knew that the simulation was set up so he would rapidly decompensate. Advanced lifesaving measures would be required.
A voice overhead, "The simulation is commencing."
We looked at each other, suddenly nervous from the utter unfamiliarity of the testing center, a perfectly simulated hospital room down to the sheets on the bed. We hadn't been tested here before. The realization sinks in that none of us have ever given orders in our lives.
I fool around for 2 minutes trying to figure out how to get the monitor to display blood pressures and the cardiac rhythm. Without these and a few other critical vital signs, we'll never know how to proceed.
Dr. A goes to introduce himself to the "patient" - a million-dollar state of the art mannekin - and asks what's wrong. A groan issues from Mr. Jones. This isn't good. His pulse is weak and rapid. We crowd around the monitor, tapping buttons and fiddling with wires. Precious time is lost.
We stand, each working haphazardly. The patient is in ventricular tachycardia. Algorithms temporarily forgotten, we debate. Do we shock or give drugs? What's more critical, heart or lungs? More time is lost. The patient, previously ill, is now dying as fast as he can.
The decision is made to put him on a ventilator. Oxygen levels have been dropping and he is unconscious. Dr. E prepares his equipment and we spend another few minutes trying to find the drugs we need to paralyze the patient prior to the procedure.
The procedure is hard, almost impossible. 8 of our 10 minutes have gone by and we have idly sat by doing nothing. Dr. A and I watch Dr. E sweat through the intubation, offering advice.
The horrible "BEEEEEEEEEEEEEEEEEEP" of flatline issues from the cardiac monitor. We've killed Mr. Jones.
"Doctors, you may leave the room," a disembodied voice informs us, "we will perform remedial testing in 30 minutes."
We shuffle out of the room, heads hung low. Added to the shame of failing at our chosen specialty was the horrible feeling that we just killed someone. It was just a mannekin, sure, but those 10 minutes felt all too real.
We spent our 30 minutes figuring out what went wrong. I think I grew up more in that half hour than I have in the past year. I am not comfortable wearing my doctor shoes but like it or not, I'm wearing them now. Why didn't anything get done in that simulation? Because we all waited to be told what to do.
Who am I to tell a nurse who has been working 20 years that I want things done my way? I only received my medical diploma in the mail a week ago. And yet, if I don't tell that nurse what to do... it won't happen. This is, in fact, the career I have chosen. To give orders, not to follow them. I need to get comfortable with that. And I need to be ok with the fact that I am a doctor.
We draw straws. Dr. E is going to lead the code. Dr. A and I will act as his assistants. The code starts. Dr. E methodically works through the algorithm. A-B-C. IV-Oxygen-Monitor. Ventricular tachycardia.
It runs like clockwork, Dr. E truly acting like a doctor. I'm proud of him. I follow my orders, giving advice when he asks what the next step is. The final decision is his.
We lose a pulse, but we know what to do. Dr. E asks me to commence CPR while he fires up the paddles. The simulation is fake but the defibrillator is real - when he calls "CLEAR" we stand back. A shock is delivered. A few more cycles of CPR and suddenly we feel a pulse.
The voice, from overhead, "Congratulations, Doctors. You are now certified in Advanced Cardiac Life Support."