Doctor blogs and books intended for laypeople tend to follow a set framework which follows the pattern set by “new doctor” story arcs on the TV shows. These people all picture themselves as Dr. John Carter or Dr. Meredith Grey. And within this structure, there comes the inevitable chapter where the author describes in loving detail the first time he reached down and saved a life.
The scene is never all that much different than the TV shows they follow: the breathless nurses, the cardiac monitors going crazy, the calm and controlled senior doctor, the young hero just barely keeping it all together in the face of overwhelming stress. This piece quoted in Slate is a typical specimen, serving first and foremost as an advertisement for the doctor’s own greatness, name-checking in the very first sentence his Harvard education and Columbia training. Whee!
On my end, the first time I did chest compressions on a patient was when I was a fourth-year med student, and let me assure you, it was nothing like ER. Everyone was pretty calm about it, even the greener-than-green student (that would be me). After all, in the ICU, this sort of thing is a regular occurrence, about as exciting as a food delivery. Scratch that — food is always far more exciting to the ICU staff. Anyway, I was given the duty of chest-flailing because it is by far the least complicated, most labor-intensive part of the ACLS routine. The critical-care fellows (post-grad residents training to become ICU attendings) oversaw and handled the drugs, the RNs placed lines and bagged, and the student handled what they saw as the scutwork (yet very important scutwork) of compressions. The author is right about one thing — the beat of Staying Alive really does closely resemble the recommended 100 compressions per minute. And my patient too survived, incidentally…
… which just pissed off the senior CC fellow. You see, the patient was seen as slowly circling the drain, but the family refused to give a DNR order, and he felt the successful resuscitation just put off what is euphamistically termed “disposition” by a few days. Like all residents and fellows, he was interested in disposition first and foremost, which translates to getting patients off his service by any means necessary (which begets the phenomenon of “turfing,” which is for a separate discussion).
And feet-first is considered an acceptable disposition from the ICU.
That brutally cynical side of real-world medicine never really makes it onto the doctor books and blogs, outside perhaps House of God; neither does the teamwork of a code. And the author quoted in Slate is not ambiguous about his importance: the patient he did chest compressions on was the life that *HE* saved, despite the presence of a senior resident who did the decision-making, and the RNs who in real life would have done the lion’s share of the work. Do I feel the same with my case? Absolutely not. The TEAM saved that patient’s life, and I consider myself blessed to have been on that team, even as the lowest-ranking member.
So let me tell you about the first life that I really did save. I didn’t have to wait for residency or even fourth-year for this one. It happened during my very first rotation as a third-year med student.