So it turns out that when you are on your research block you have absolutely nothing to write about. Patients are funny, residents are funny, and hapless medical students are hilarious, but there is absolutely nothing funny about research. My project is in the field of medical education, which I find intellectually stimulating and worthwhile but primarily involves attending meetings, reading journal articles that freely use phrases like “cognitive load” and “contextually embedded orchestration of skills,” and sitting in front of a computer.
All that led to me getting glasses (seriously).
Still a little bit of Bell’s palsy hanging in there on top of the failing eyesight. Ugh my body is quitting on me.
In my search to avoid losing what small percentage of clinical acumen I have acquired during my time in school, I found this random app/game called “Resuscitation!” Resuscitation!, the brainchild of an ED physician, is fake-doctor fun on an iPad: it presents you with a patient in the emergency room and lets you Do Things, like put them on the monitor, start IV’s, give drugs and order labs, etc.
If you look on the side, there’s a scoreboard of sorts that lists what actions are critical to perform, bonus actions, and things you ordered that were maybe not the greatest thing in the world. When you do something critical you get a rewarding green highlight around your order. Once, I ordered a needle thoracostomy (which you really don’t want if you don’t need it, trust me grandma) on someone who had heart failure. That got me a big red “HARMFUL.”
HARMFUL is -20 points. Yes, it gives you a score at the end, including a rank (Student, Resident, or Attending). Yes, it is addicting.
So this Resuscitation! thing has become my new time-waster, which I suppose is a step up from abusing my roommate (Ragemonster) in Madden. I am getting pretty good at it and usually only miss a couple of “critical actions” per case, unless of course the patient has Turner Syndrome. After doing my EM rotation earlier this year and taking Step 2 this winter, I feel like I can handle some bread and butter stuff.
Go me, I am awesome, hello ego.
(This is referred to by my mom, the author, as foreshadowing. Or maybe ‘pride goeth before the fall.’)
I ran into one of my mentors, Dr. C., at our college’s office hours a couple days ago. Dr. C is a pediatric critical care doctor and I thought, hey, he will probably like this.
I whipped out the iPad and pulled it up. “Hey, Dr. C., want to see this cool medical app thing?”
“Sure…” he said doubtfully. As an Official College Mentor he is required to display interest in his students even when he thinks it is stupid, which I shamelessly take advantage of since I am nothing if not an open narcissist.
I pulled up the menu and hit “Random Unplayed Case.” The scenario loaded and displayed the one-liner: “17 y/o male with acute onset shortness of breath.”
“What do I do?” asked Dr. C. I explained the format and that you can do things like start an intrave-
“Okay let’s start an IV,” he said, pushing the blue button on the screen. “How do I get vitals?” he asked.
I showed him where to tap to put the patient on the monitor. “Ooh, this is cool!” Dr. C said, yanking the iPad out of my hands. The patient’s vitals came up.
“He has a pneumothorax. I’m gonna place a chest tube and get an xray and put him in the ICU and and and…” he exclaimed gleefully, his hands tapping away on the screen. When he hit “SUBMIT ORDERS” and the game started scoring his decisions, I busted out laughing – the scoreboard because a straight-up wall of critical green. By the time a minute of game time had elapsed, Dr. C had completed eleven of thirteen critical actions, all the bonus actions, and hadn’t performed a single unnecessary thing.
“What are the other critical things!?” Dr. C yelled. “WHAT AM I MISSING?!”
“Well, you haven’t taken a history or done a physical exam yet,” another student piped in.
Dr. C looked perplexed. “But… I fixed him already,” he trailed off.
Catching my breath between paroxysms of laughter, I had Dr. C hit the FINISH button to get his final score. He only missed two things, the history and physical, and got a score of 96%.
Total time elapsed: 2 minutes, ten seconds. My average case time was about a half hour. That pneumothorax case would have taken me at least 45 minutes. I was laughing so hard because for all my posturing above about Knowing Some Things, the medical knowledge gap between me and an actual doctor is still far larger than the knowledge gap between me and the dad from My Big Fat Greek Wedding who believes Windex cures everything.
Humor for me is a soup-like mixture of actual amusement, shame, and Impostor Syndrome inferiority complex.
“Hey, what’s that?” my other college mentor, an awesome ED doctor named Dr. P (whom I maybe possibly follow around like a lost puppy), asked.
“A game. Here, watch,” Dr. C said as he hit the PLAY button.
The one-liner: a 76-year old man with bloody vomiting.
“Upper GI bleed. Start fluids, make him NPO, oxygen, basic labs and coags, type and cross for a transfusion, give him a PPI, start octreotide and some CTX, maybe drop an NG tube, prepare for a Blakemore, consult GI and get him to the ICU,”
Dr. P leaned back, grinning, and linked his hands behind his head.
“Okay give me that,” I grumbled and reached for the iPad. Office hours were over.