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Emergency Medicine News

Narrative Medicine

Twenty Seconds

O'LACO, Karen Anne

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doi: 10.1097/01.EEM.0000657852.35786.3d

    I have always been eager to learn, but it was surprising to discover how often I shirked learning opportunities because of the fear of being bothersome or judged as incompetent.

    Medicine had muted me.

    I had grown accustomed to being invisible in the operating room. I had heard my share of horror stories, so I was OK with that. My presence in the room was ignored, but at least it wasn't regarded negatively. Naturally, I latched onto any person who was willing to teach me. No matter how small the task, I wanted to do it.

    So when my chief resident asked if I had ever put in a Foley catheter, I jumped at the chance to participate in patient care. It wasn't exactly a glamorous task or even remotely crucial to this patient's surgery; he was in for an I&D to rule out necrotizing fasciitis. It was also a red line case, a strategic way many surgeons ensure OR time before the workday was over. Even under those circumstances, my chief still gave me the opportunity to learn. I prepared the kit and started the process with the circulating nurse.

    Meanwhile, the anesthesiology resident behind the curtain circled the table and approached the computer station 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. His disdain was almost palpable. My panic grew as I tried to finish the task.

    “This is a teaching institution. If you had a student, I wouldn't say that she couldn't put in an IV. We can afford the extra 20 seconds for her to learn,” my chief responded.

    I don't know why, but all I felt was shame and embarrassment as he went back to the head of the bed. Clearly, I was not welcome in the room. Not only did I not belong, I had caused an awkward division between care providers.

    Should I have spoken up? Should I have apologized to the anesthesiology resident? Maybe this wasn't an appropriate time for teaching. The hierarchy never felt so concrete. Stuck in my own head, I had somehow missed the entire case. Physically present, mentally absent, just like my grade-school teacher had scolded 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 occupied with placing orders, reversing sedation, and notifying the family. Suddenly, his plump red neck started to turn blue. The color crept up, 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 anesthesiology resident turned toward the patient, and chaos ensued. The oxygen sats continued to decline with a nonrebreather. 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 “30%” flashed on the monitor as 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 reintubation. Within seconds, he established an airway as about a dozen more people flooded the room.

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

    Why didn't I say something to the anesthesiology 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 2.7 minutes in the morbidly obese, less than half the expected time compared with a normal-weight patient. Twenty seconds. Would it have made a difference?

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