Aug 22, 2011

Airway Management

I'm part of the medical team. Being a medical student in a medical team means you get to try out stuff under the eagle eyes of your superiors, and get blamed when things don't turn out as expected. You're expected to know all of them - endotracheal intubation, arterial lines, central venous catheterization - the moment you wear your white coat. Much in the way a baby bird is pushed from the nest by his mother and suddenly grasps the majesty of flight. The kicker is that my superiors never knew I learned all these "skills" in a 2-hour session spread over 4 weeks.
So during my first week in anesthesiology, everybody expects medical students to magically know how to intubate patients and make them fall asleep with a snap. I'm sorry, sir. The last time I studied anesthesiology was last year - the 2 volumes of Miller's Anesthesiology all crammed into 2 days of 8-hour lectures. It's a miracle I can vaguely recall propofol is the "milk of amnesia" and laughing gas is no longer in trend for anesthesiologists.
Nevertheless, it is always the student's fault - you should have studied before you come, you should have got ample practice, you should do one million other things other than eat and sleep. They never reflect upon themselves the crazy timetables and a gazillion things crammed into 50-minute sessions - back in their time anesthesiology was a full-semester course with coursework and mid-terms; now it's a 16-hour marathon and finals.
Being responsible medical student and part of the medical team, I practiced and played catch up. After countless practice (on a mannequin with broken lips from all the abrasion of the laryngoscope), I grasped the instinctive "feel" of the deepest portion of the throat - the laborious pivoting a mass of soft tissue called tongue northward before exposing the holy vocal cord, like casting the Patronus charm if you just concentrate hard enough.
After a weekend of aimless wondering around my new room and eating tasteless self-cooked meals, I'm all ready to intubate my first patient on Monday. As the nurse handed over the endotracheal tube, casting a if-he-fails-I'm-killing-you glare at my attending, my hands were all cramped from 3 minutes of masking the patient weighing 108kg. Pretending I've been doing this for 20 out of 23 years of my life, I pushed against the forehead in an attempt to extend the patient's neck.
"First step wrong!" My attending barked. As I extended the blade to "isolate" the tongue, making ignorable mistakes along the way, all hell broke loose among the stadium of spectators around me. "Have you seen the vocal cord?" "Don't press too hard against the teeth, you'll break it!" "Now careful! I said CAREFUL!" "Don't touch the tubes with your contaminated hands!" "Remember, first thing to do in an emergency - call for help!"
After what felt like a century navigating the gulp-sized oropharynx, I indicated the opening is in sight. With everyone holding their breath turning purple, I proclaimed "it's in!"
The nurse snatches the stethoscope from my neck and listens suspiciously to every nook and cranny of the patient's lungs. My attending kept watch on the CO2 monitor and bagged the patient while I prayed so hard that I'd hit home run. When the flat yellow line started rising, I knew my tube went to the right place instead of the esophagus. Now it's the nurse's turn to see if I went too deep and only intubate one, instead of both lungs.
"Equal and clear," she said, throwing a if-you-screw-this-up-I'm-killing-you glance at me.

As my attending praised me for my successful first intubation, I pretended to be cool and took dozens of ID stickers to gloat on my patient care list. I filled the columns with headlines such as "first endotracheal intubation - a wild success!" Then strolling up and down the 20 ORs waiting for my next victim.


yiu said...

WAAA……congratulations!=) 讀了都會跟著緊張