Tuesday, May 10, 2011

Paradigm Shift

I've had a hard time writing about the transition from nurse to doctor, mostly because there have been so few reality checks that cause me to stop and think: holy crap, I am going to be the DOCTOR one of these days, not the nurse! YIKES!!

There is so much overlap* (whether doctors like to admit it or not) between the two that I haven't felt some big jump yet, from one role to the other.

Most of the time while I am in school, it just feels like I am in an advanced nursing course and I forget that I am in medical school. When I was doing my 'observership' in the hospital last summer it was somewhere that I also worked as a nurse, so I always felt more nurse-y than med-student-y, to the point where I felt awkward around my fellow nurses sometimes when I was in the observership role. I wanted to say to the nurses who were around while I was being pimped, "what are your differentials?" because I knew they had several to list as well.

Last night I had one of those "holy crap I am going to be the doctor" moments in the USMLE prep-course. We were talking about epiglottitis and my heart reflexively constricted in fear remembering the horror stories I had been told about non-immunized drooling babies showing up in ED's and dying due to mismanagement/misdiagnosis. It was drilled into me in every ED course, exam, orientation, and neonatal resus certification class:

do not agitate the baby
deliver high flow O2 in the least invasive way possible
don't even try to get an O2 sat if it is going to agitate the baby
do not attempt to look in the baby's mouth, etc. 

So, when we got to the question about the case of epiglottis and the prof asked what you do I reflexively answered all the above.

Um, no...you intubate, immediately. 

Right, of course. My thought box on the matter was how I would react / treat the patient if I was the triage nurse. Those are the steps I would take until I was able to get the patient to the doctor.
[Small line drawn through mental list of things to do when presented with a patient who has epiglottitis.]

Now that part of my brain contains the following info:

Holy crap. You're the doctor. DO SOMETHING!!!

---

*At least I have found this in the ED and in the Arctic.

5 comments:

Red Stethoscope said...

You have such an interesting perspective, but yes, I could see how the role change could end up to be challenging.

Old MD Girl said...

Well, for what it's worth, we were supposed to memorize all of those, "DON'T AGITATE THE BABY AND FOR THE LOVE OF GOD DO NO STICK A TONGUE DEPRESSOR IN ITS MOUTH," things as well as the intubate part. So you're about 10 steps ahead of most med students like it or not.

;-)

Albinoblackbear said...

RS--Should be interesting in a few months when I am in clinical (like, for real...not renegade-OR-crasher-rotations).

OMDG--Ok, well that is good to know because he looked at me like I was a re-tard and told me "that is how you manage croup, in epiglottitis you intubate or baby dies".

I am only about 10 steps ahead when it comes to ER situations...everything else...it's a crap shoot! hahahah And if it is biochem or med gen I am prob about 37 steps behind! :D

iamnothouse.com said...

Yes, but it's amazing how few medical genetic emergencies there are. In fact, I think they're on the order of...none.

I definitely think you have an advantage, if nothing else, in knowing the intricate maze of bureaucracy that frames the hospital, you'll be several steps ahead of all your classmates, and can focus more of your time on "learning medicine"

drottematic said...

haha great revelation

you'll be fine

and sometimes, we still look at the nurse (who knows more!) to do something.

*please let the nurse do something because shit I don't know what to do!*