scary first encounters

 

Window art~Jack Frost's finest.

If you are a healthcare provider...a doctor, nurse, physician's assistant or nurse practitioner, EMT, or other first responder...you had to navigate some pretty rigorous training to prepare you for your job. Scary stuff. Scary enough that you might still recall the feeling your autonomic nervous system registered for easy reference later on in your career. The knot in your stomach whenever you approach a spinal tap. The ache in your chest whenever you charge up the paddles. The way your heart races before you make that first incision. The vagal nerve wants to remind you what it felt like the first time you tried. 

"Do the thing you fear to do,

and keep on doing it."

~Dale Carnegie~

This is exactly what we are called to do in practice. Which explains the vague sense of anxiety some of us feel every day. We don't don't know what the next patient will need from us. It worries us a little even when things are going well.

Here is a list of my top contenders for:

Scary First Encounters

• Performing my first spinal tap (lumbar puncture) and, for that matter, every one since then...because it requires you to aim a big, long needle into a fluid filled space you can neither see nor feel that is millimeters away from the spinal cord. What could possibly go wrong?
• Taking charge of a Code Red (CPR) by myself, calling out orders, processing changes in the patient's cardiovascular, respiratory, and metabolic status. And knowing when to call it off.
• Inserting my first subclavian line...aiming for an artery that is hidden from sight and is impossible to palpate because it courses behind the collar bone. Meaning, it's a blind stab.
• Delivering my first baby...performing the episiotomy, easing new life into fresh air, hoping nothing gets stuck on the way out. Listening for that first lovely wail...because sometimes it doesn't happen.
• Intubating a patient, because you can blow out a lung or damage his vocal cords if you don't get it just right.
• Performing arterial punctures because they're just so painful, especially when you're forced to go in after the femoral artery.
• Performing pericardial/thoracic/abdominal paracentesis to draw off fluid or blood from a potential space surrounded by critical organs you can't see.
• Performing any procedure that causes pain to an infant or child, like drawing blood from a scalp vein in a newborn, for example, or performing a suprapubic bladder aspiration on a baby. Do they still do that?

We are trained in these procedures so we'll be prepared to perform them when we are out on our own. Still, as many times as we are called upon to perform them, that vague sense of dread, fear, and insecurity can follow us through life, wiring our autonomic nervous systems to betray us even when all is otherwise perfectly calm. 

"The greatest mistake we make

is living in constant fear 

that we will make one."

~John C. Maxwell~

What makes you anxious about patient care? What do you fear encountering in the office, or at the scene of the accident, or in the operating room? What procedure scared you most when you did it for the first time?

"You must find the place inside yourself

where nothing is impossible."

~Deepak Chopra~

jan