A Shocking Experience

As we stand around the bedside of our patient, the family anxiously tells us that he was found that morning with vomit and blood around him. The bells are going off in my mind that this man is in hypovolemic shock. The sounds of machines taking his vital signs continue to beep. I see his blood pressure dropping lower and lower before my eyes. With only a year and four months of medical school under my belt, my team and I feel incredibly inadequate to take this man’s treatment into our hands. We quickly begin to realize that we do not have much time to simply stand there, so we begin fulfilling our roles taking a history, physical exam, and ordering tests and treatments that we have only read about. I got on the phone with the pharmacy to order normal saline to replace his fluid loss. The pharmacist asked me how much I wanted to order. My mind went blank. I looked at my teammate who looked back equally as unsure. With some unsteadiness, I replied back that we wanted one liter of normal saline. As I watched his vitals to see what effect this would take, I quickly knew that we were going to need much more. With each time that I called the pharmacy for blood, fluids, or antiemetics, I became increasingly more confident in what I was ordering. Over the course of a few minutes as we gained more information, ran more tests, and administered more aggressive therapy, we began to watch his vital signs improve. We were about ready to send him to endoscopy to look for ruptured esophageal varices when all of a sudden, a voice came across the loudspeaker saying that the next team was up. Before you get too concerned about patient safety at Loma Linda, I should probably let you know that this was just a learning experience in our Simulation Lab that combined our knowledge of pathophysiology and pharmacology into an afternoon of anaphylactic, hypovolemic, and cardiogenic shock.

My team and I with our assigned roles.

In the few hours that we spent working together in lab, each team took turns getting to be the physicians. Those who were not actively participating sat on the sidelines, stopping the situation if there was a treatment that they felt was unsafe for the patient, conferring with others about the best course of action, or being entertained by the flurry of activity in the room. Although there was a mutual tone of anxiety throughout the room because of the unknown, there was also a lot of fun, learning, and laughter that came with it as we watched each other have a “deer-in-the-headlights” kind of experience. For those of us who are kinesthetic learners and/or adrenaline junkies, this was one of the highlights of medical school thus far. It was exciting to be thrown into a situation that might take surprising twists and turns, yet where you were challenged to maintain some semblance of calm in order to think clearly through the chaos. It was encouraging to see both the practicality of the information that we are learning and how much we are actually retaining. Most of all, it was inspiring to catch a glimpse of what it is like to walk in the shoes of the physician. When most of my days seem to be a blur of sleep, study, go to class, exercise, study, eat, study some more, and repeat the next day, this experience was just what I needed to inspire me to keep moving forward.