I’ve been in emergency situations before, but I was never the one responsible for the outcome. Yesterday, a six-year-old boy named Derek was brought into the ER for a severe asthma attack, and it was up to my team and me to turn a dangerous situation into a positive ending.

Here’s the catch: this experience was a simulation. It was a mock event brought to life in the JUMP Simulation Center, an experimental learning environment in Everitt Lab where we learn and practice our clinical skills. So while no one was in any danger, I did get my first taste of a intense, high-stakes situation for which I am responsible – one that I’ll experience many more times during my future career as a physician.

My classmates and I were on just day four of our new respiratory block. All 32 of us gathered into a room, knowing only that we were about to participate in a simulation. Dr. Rowen, our associate dean for academic affairs, gave us the case basics in a PowerPoint. We partnered with respiratory therapy students from a local program, and while we were just getting started with respiratory, they brought two years of simulation and clinical experience. I came to appreciate later in the simulation how beneficial it was to have their prior training.

Then came time for the simulation to begin. I expected to walk into the room to find one of our clinical professors detailing the patient’s condition, and guiding us through nasal cannula placement and albuterol treatment.

Instead, I heard, “Please! My son! Please help!”

After we overcame the initial shock, my classmate and I realized that we were not going to be playing the role of observer. This was on us. Meanwhile, the respiratory therapist had already snapped into gear, and knew exactly what to do. We followed her lead, and began asking the dad about the patient’s history. As an MS1 in the first week of a block, you don’t have a ton of solutions to offer just yet. However, being in the clinic since July has given me the experience to confidently elicit the patient’s story. So while the respiratory context was new to us, we could begin offering this skill we’ve been practicing in the clinic over the past few months.

I auscultated the mannequin and heard surprisingly realistic expiratory wheezing. The monitor showed that Derek’s oxygen levels were not changing much with supplemental oxygen. The respiratory therapist then started the nebulizer, and thankfully, his oxygen levels began to climb.

Dr. Greeley, one of our clinical professors, had been playing Derek’s dad. As Derek’s condition improved, he switched back to his real-life role as our professor, and helped us think through the decisions and actions we made.

What I Learned

Stay calm. In the future, when I experience the initial shock factor of the patient’s situation, I’ll need to learn to channel that into a plan and act swiftly. I’ll need to quickly gain information so I can treat the patient effectively.

Also, working with the respiratory therapist and my classmate reinforced the benefit of collaboration and working in a team. I was relieved to defer to the respiratory therapist’s experience in this situation, especially in the initial emergency.

Moving forward, the Simulation Center can be open for us to practice any time. At this point in my education, the benefit of this simulation was probably to throw me into a situation where I was in over my head, which would cement the experience into my mind as I dig into the rest of the respiratory block. Over the next several months, I’ll be able to use the Simulation Center to practice and improve a broader range of skills. In the meantime, it certainly made learning more fun, and makes studying the rest of the respiratory block more motivating, as I can now look back at this near-real-life experience that I’ve already encountered.

October 15, 2018