Simulated stimulation

It's finals week, so what better time is there to catch up on my blog...

Last week, we had our first session with UC Davis' newest toy: Stan the $250,000 Mannequin which is used for training purposes in situations where you'd rather not be learning on a live -- or dying-- person.

Over the next few years, we will hopefully have frequent encounters with Stan and his kind, as we practice intubation, pulmonary artery catherization and all those other fun procedures that doctors do everyday and that medical students are petrified to do for the first time.

Our first encounter with Stan must have been hilarious to watch. After almost two years of sitting in the classroom and practicing rehearsed physcial exams on volunteer patients, we were told to show up at the main hospital "SIM Suite", dressed professionally and with stethoscopes in hand. The first hour was spent learning how to "bag" a patient (manually give them air) followed by a percursory introduction about what to do when the patient's heart stops beating. Strangely, many of my classmates had never had CPR training (apparently, saving life was not a big concern during their premed years?) and the bored anesthesiologists (what did they do to get _that_ job?) who were putting us through the motions did not seem concerned with technique. (I found it slightly disturbing that people who were going to be spending all their waking hours in the hospital next year were lamely making 1/2 cm massage-like compressions, many of which were directed sideways as if they were trying to shave off the patient's ribs or, best yet, over the right side of the chest.)

The day got a lot better, however, when -four students at a time- we were taken into a little "crash" room and introduced to Stan, the plastic, quarter-million dollar "truck driver" with a female voice and amasculine features, who was "brought in on a stretcher complaining of chest pains". With no instructions we were told to "take care of Stan".

As Stan moaned on the stretched before us, we stood paralyzed, looking desparately from one person to the next, trying hard to remember what George Clooney does on ER when a patient is brought in.

"So, what are y'all gonna do?" asked our MD facilitator, who could not have possibily still been amused since we were the fourth group in such a position that day.

"Um, maybe hook him up to an EKG???" one of us whispered uncertainly.

"Sure. We'll hook him up to the monitor so you have EKG, oxygen sat, and blood pressure--" and the monitor behind my head lit up with vital signs, "--what next?"

"um, call a doctor?"

"You are the doctor, so what else would you like, Dr....?"

"Um, maybe some nitroglycerin?"

"How about before that. The patient is moaning, having a hard time breathing. Not doing so well. What else do you think he might need right now?"

"um......?"
"......um?"

"How about oxygen, Dr? Do you think he might want some oxygen?"

"oh yeah..."

The simulator class continued in this painful and embarassing way for the next 45 minutes, with our patient coding in front of us and the four of us successfully reviving and stabilizing him so that we could pawn him off on cardiology. Though intensely humbling, the experience was also remarkably inspiring. We were slowly taking the academic knowledge we had learned over the last two years and painfully converting it to practical knowledge in this pressured, but consequence-free, setting. (Lidocaine really is used to stop cardiac arrhythmias in an acute setting just like that random pharmacology powerpoint slide said!) By the end of the experience I felt like I had a complete picture of everything that needs to be done to stabilize a coding patient ...and I had learned it in a way that would be difficult to forget.