Less cannulation and more caring
How did I get to be a final year student already? Where did the past four years go? And how did I manage to retain such a pathetic amount of information and forget so much? It's now or never - I feel that there is a lot of stuff to be learnt before I could ever be a doctor. I throw myself into the deep end with a rotation in the accident and emergency department of a district general hospital in Yorkshire, something of a shock after my sun drenched elective. The pace could be fast and furious, with a rapid turnover of patients and an incredible diversity. From someone with a head injury, to a little boy with a marble up the nose, a man with chest pain to a simple splinter in the big toe.
I wanted to see as much pathology, practise as many skills, and learn as many of those surgical gems as possible. Finals only a year away, I kept telling myself, do lots of doctor-type stuff. Patient after patient, history after history, bloods, x rays, watching procedures, my learning environment was serving me well. Somewhere along the way, however, it went a bit wrong.
Patients became their condition first and a person second. Where was that heart failure from curtain one? He must have gone to radiology before I had a chance to cannulate him. It's a shame that that woman's laceration only needed steristrips - I'm getting quite good at suturing. Is the asthma attack in the bed bay sick enough to do blood gases on? I failed at my last attempt and am keen to try again. Let me do the electrocardiography on that chap; I haven't ticked it off my skills list yet.
The white phone rang one morning, silencing the general hubbub as we waited to hear details of the incoming cardiac arrest. I'm ashamed to admit that my first thought was which component I wanted to do. It was chest compressions last time, so maybe I could have a go at the |P`bag and mask|P' this time. The ambulance arrived, and the trolley rushed in, bearing a man who looked younger than my dad. His distraught daughter ran behind. The ordered activity began around him - airway, breathing, circulation - while his family were shown into the relatives' room. I noticed his wedding ring and the work clothes he still wore, with the council logo on his luminous jacket. His possessions were handed over by the ambulance crew.
I was appalled at the Katie I had been only minutes before, treating this as a teaching session to hone my skills. This was a son, a father, and a husband. I'd somehow missed the point of my contributing, the reason I'm learning things and becoming good at being a doctor. It's not so I can tally up the number of hands I've stitched, the number of cannulas I've done, or number of resus cases I've witnessed, and feel good about myself. My learning medicine isn't about me. I should be striving to be a good doctor so that I can be just that for the people I see, the patients I will be working with. I realised my people skills had taken a back seat while I concentrated on the practical stuff. Despite everyone's efforts, the man died. Instead of staying to watch the extubation, or palpate a carotid pulse that was no more, I went with the staff nurse while she broke the news to his family.
Katie Wright, final year medical student, Sheffield University
studentBMJ 1999;07:394-436 November ISSN 0966-6494
