Monday, September 17, 2012

Shock and Awe: Dispatches from a First-Year Med Student | Healthland |

My very first patient died — twice.

Less than a week after our White Coat Ceremony — the symbolic start of our medical education, in which we donned short white student coats in front of faculty, friends and family — I, along with a dozen other first-year medical students, am training in basic cardiac life support.

Our mock clinical scenario: an elderly woman (fortunately, a mannequin, whose vital signs the EMS instructor makes up as we go along) collapses in a ShopRite supermarket, aisle 3. Unresponsive, she has stopped breathing. We check: no pulse. The instructor is quizzing us on the emergency response protocol. Then he asks a different type of question: "Is the patient dead or alive?"

This is just the type of conundrum I am eager to chew on with my new classmates. It's of a piece with the ethical, emotional and big-picture issues we've already started exploring with faculty lecturers — and with each other, in the dorms and in cafes near campus — during orientation week. What is the definition of "dead" or "alive"?

"That's a complicated question," one student ventures. But this is, after all, a clinical class — time for skills practice — and the instructor wants an answer.

Most of us choose "alive." The correct answer, he informs us, is "dead."

"That's what cardiac arrest actually means," the instructor deadpans. "We just don't tell that to the families."

He moves on quickly to show us the proper hand placement for cardiopulmonary resuscitation, or CPR, and explains how to use the defibrillator. But I'm unsettled. Unlike the patient, a plastic-and-foam mock-up, the defibrillator paddles are the real thing, capable of delivering 200 volts in a fraction of a second: enough energy to stop the heart.

Glancing from the gurney to the paddles, I feel my stomach tighten. What if I don't notice that one of my classmates is touching the mannequin and I stop his heart, too? If a patient in cardiac arrest truly is dead, then why does it feel as though shocking her chest would violate the sacred edict to do no harm?

Like a kid standing on the diving board but not quite ready to jump in, I hope that maybe today when we start defibrillating practice, the instructor will choose someone else.

Turns out I get picked. My own heart racing, I press the paddles to the mannequin's chest and discharge. The shock fails to restore the patient's heart to normal sinus rhythm. I trade off with my classmates: chest compressions, rescue breathing, paddles. No luck. Eventually a flatline shows up on the monitor."What's that telling you?" the instructor asks. "It's the heart saying, 'I'm done. You had a fifty percent chance of getting me back, and you let it slip away.'"


I am surprised by how heavily these words land. It is, after all, only a simulation. My classmates and I have done everything by the book. I figure the instructor wants to run us through all possible scenarios, including a patient's death.

But one day the patient on the gurney will be flesh and blood. I know that as I move forward with my training, I will grow more comfortable with the actions required to help my patients, and less fearful. But I hope I never forget the feeling I had the first time I took on that responsibility.

Awesome is a word way-overused these days. But sometimes — when wonder and power mingle with fear — it's the only word that fits. I can't imagine how awesome it will be to press those paddles against a human heart.

Fitzpatrick, a former TIME writer-reporter, is a first-year medical student at Weill Cornell Medical College in New York City. Her "Doctor in Training" essays will appear periodically on Healthland.