It is often emphasised by our tutors that you learn by teaching others, and by doing. Often the ‘others’ I happen to be teaching is whatever inanimate object within eyesight, however I am definitely a person who learns by doing. Practice questions are more useful to me than textbooks, real patients are better than plastic models. I am perhaps not the most dedicated medical student (I don’t spend every hour of my day hanging around the wards for one thing), but I see the merit in what they preach.
As if she had an ear into my thoughts, the anaesthetist wheeled the next patient in, turned around to me and said: “Come, you’re going to intubate.” She was a brusque woman, but kind, and having spent the past three hours with her, and hearing her explain to another patient why she became an anaesthetist, I already admired her. However, the only thing I have ever intubated is the head and shoulders of Alan, a clearly plastic, inhuman model with no pain receptors.
I scuttled over nervously as she bagged the patient, waiting for the propofol to take effect. “Have you ever ventilated someone?” I said no, but I was willing to try (it’s a very good phrase to use, just as a useful tip). She nodded. “Good, now this is what you do.”
I began with some difficulty, since a plastic model’s mandible is incomparable to a real human’s, and I was struggling to jaw thrust whilst holding the mask one-handed. Once the patient had settled, the mask was removed and the anaesthetist inspected the vocal cords with the laryngoscope. “Can you see the vocal cords?” I stayed silent as I searched. I have never been the kind of person to automatically say yes, as I would rather be stupid than caught out as a foolish liar. “Well, can you?” she asked again impatiently. I was lucky enough that I spotted them just as she spoke, since beads of sweat were already threatening to form along my hairline.
I said yes and she nodded: “Now feed the bougie in.” I looked up, frozen. What on earth is a bougie? Should I know this, did I learn what a bougie was? How do you even spell it? What does it even look like, how do I find a bougie?
I probably only had this minor panic for about 5 seconds because to my left appeared this long thin blue tube carried by the anaesthetics nurse, James. I could feel my tachycardia regressing as I thanked him, took the bougie and carefully fed it past the vocal cords and into the trachea. She grunted. “Now the tube.” Again the tube appeared to my left, the work of the heavenly James, and I carefully guided the tube down the bougie, hyper-aware of the fact that vocal cords are delicate and this tube was plastic and thick.
All you have to do, Priscilla, is not ruin this patient’s life.
Easy enough, really.
“Push a little harder, a bit harder, otherwise the tube is going to bend and you are not going to be putting it in the right place.” I mentally crossed my fingers and toes and added a just a tiny bit of strength.
“Good. You’re done! It’s a bit too far down because you got a little bit too excited, but I can just bring that back up again. You see these markings on the tube? If you’ve pushed it down too much you’ve almost certainly gone down the right main bronchus and then you’ll get collapse of the left lung because you’re only ventilated the right. Ok?” I nodded in understanding. She smiled. “Very good. Well done! You’ve bag masked someone, and you’ve intubated! You don’t get to do that every day do you? Well done.”
Like a puppy who has just been informed they’ve been a ‘good girl’, I beamed and felt an instant sense of accomplishment. She was a busy woman though and turned away to ready the patient for the operation and begin the paperwork. I was left to stand with a slightly more confident air by the wall, where medical students tend to be, waiting for the surgeons to return. It is one thing to successfully intubate one quarter of a mannequin. It’s quite another to say that you have successfully intubated a real patient (albeit with the assistance of an anaesthetist and the nurse). And I think having been able to do that once on my first attempt, I would be a little more confident for my next. Doing, is indeed more useful than reading.