Don’t Miss Out On This Powerful Medical School Lesson

  • /Reviewed by: Amy Rontal, MD
  • I’m struggling. When caring for a morbidly obese, dialysis-dependent cancer patient, nothing comes easy. Especially IV access. Despite being on peritoneal dialysis, affording us the use of both arms, I’m getting nowhere. I’ve got 2 blown IVs, one in each arm, and the one that he came in with from the floor is not functional either. The patient is already anesthetized and intubated, but we have no IV access. 

    I continue to struggle, and it’s clear the surgery team is losing patience. They “try to help” by standing there grumbling with their arms folded, making audible sighs and rolling their eyes. Luckily there is a nurse anesthetist (CRNA) working me. But unluckily, they are chatting with another nurse in the room, leaving me on my own in this bind.

    What skill is the CRNA is lacking in right now? He is certainly apt; I know he can place a tricky IV. But there is a lack of situational awareness, something which is incredibly germane to everything that we do in the OR. At a time like this, in which everyone is waiting for our team to complete our part of safely starting the case, they should be doing all they can to help achieve the common goal of moving the case forward and keeping the patient safe. 

    This could include taking out the bad IVs, and looking for another vein, somewhere. Or they can offer to grab the ultrasound machine. Or hand me equipment. Anything would be helpful.

    Eventually I am able to get one with the ultrasound, and everything proceeds uneventfully, but situations like this can be avoided with a little bit of situational awareness. 

    I can think of many times that fellow staff members display a lack of this crucial skill. Lacking situational awareness is something that begs to be improved. Some examples:

    Deafening laughter and jokes from other OR staff at the moment of anesthesia induction.

    Being asked inane questions (e.g., What’s the patient’s respiratory rate?) when it’s clear that we are hyper-focused on the most crucial part of a case.

    I’ve been guilty of it myself. As a personally loud phone talker, I’ve picked up a call and spoken incessantly loudly during a crucial time that demands quiet. 

    My personal gripes won’t make you a better medical student or resident. But here’s a few things that will. Understand these situations…and then do the exact opposite.

    Keep your head on a swivel, and think “What can I do to help?”

    Tie up the scrub nurse’s gown if she’s waiting for it.

    Save questions for appropriate times.

    Take care of the sharps when someone is applying the dressing during line insertion.

    Get your patient a tissue if they are beginning to cry.

    Anticipate what’s going to happen next, and be there to smooth the next move. 

    It can be difficult to figure out what the next step is. And early in your career, that’s permissible. But a simple question will help you stride forward:

    “What can I do to help?”

    Usually there’s something. And if there’s not, at least your genuine desire to help has been explicitly communicated. There will be times, as a medical student, when there will be nothing for you to do. In that 8-hour lysis of adhesions, your job might be to keep your hands folded on the patient’s last rib, and answer PIMP questions. But in most situations, you will be able to offer something. 

    Think about ways to improve efficiency. 

    This past week, I was putting in an A-line, as the surgery resident stood there next to me. His arms were folded, prep stick in hand, and he was visually frustrated by the fact that my necessary procedure was delaying him.

    I asked him, “Can we co-exist? Go ahead and prep while I do this.” There was plenty of room, and the tasks were easily performed concurrently. Getting frustrated will never do anyone any good. Find a way to help, find a way to keep things moving forward, and it will get noticed. 

    Situational awareness is a really important skill that cannot be taught, but must be developed. Remove yourself, for a moment, from being hyper-focused on the current situation, and read the room. Decide if you are doing what you should be doing, who and how you can help, and as always, your patient(s) will be the benefactors of your enhanced skill.

    Further Reading:

    (MedEd)itorial: Helping Others While Becoming Better Versions of Ourselves

    (MedEd)itorial: On Your Path to MD, the Truth Will Set You Free — Typically Right After it Pisses You Off

    Leading By Example: Leadership Opportunities at the Hospital

    Photo by RODNAE Productions from Pexels