Close to two months of my first year of medical school have passed, and I finally feel as though I am getting my feet under me. UMMS has certainly been a whirlwind so far! Here’s a quick introduction to who I am: I grew up in a small town called Manchester, MI, and attended undergrad at Juniata College, studying biology and Spanish. After graduating in 2014, I worked as a research assistant with a pediatric nephrologist at the University of Iowa, then started at UMMS this fall. Today I’ll write about the Initial Clinical Experience, a new curricular component here at UM in which M1s shadow different members of the care team. It’s been one of my favorite things so far because I enjoy being in the clinic and I am learning a lot about what different health workers do.
On Thursday, I shadowed a respiratory therapist (RT) in the neonatal intensive care unit (NICU). I have previously shadowed physicians in the NICU, and so I was looking forward to returning to a familiar environment while seeing it from a different point of view. The RT I followed (I’ll call her Jen), seemed concerned that she didn’t have enough of interest to show me, but she needn’t have worried. I spent much of the afternoon trying to understand the many types of respiratory support available and when each would be favored (I was only partially successful on this front!). Jen showed me jets, oscillators, traditional vents, and a seemingly huge number of different CPAP set-ups. But more impressive than her knowledge of the many machines was the realization that she, like most RTs, was trained to work with both adult and pediatric populations, and that a pediatric RT like Jen rotates through an incredibly diverse array of patients (at UM all the Mott RTs rotate through the NICU, PICU, and pediatric cardiology units). That the RTs can switch between these different patient populations is impressive.
As I watched Jen, the lines between work assigned to the nurses, the RTs, and the physicians, at first blurry, slowly came into focus. And as equally spaced and balanced as these lines seemed to be, I also clearly saw the manifestation of a hierarchal division of power and ultimate responsibility. At one point, Jen and another RT were working together to deliver a dose of surfactant (a lung lubricant) to a tiny 2-day-old patient. The dose, a liquid suspension injected into the lung, was given, and the patient’s oxygen saturation began to fall: 85…75…65…55…45… With every drop in saturation, the tension in the room rose. The RTs changed the vent settings to optimize oxygenation, to no avail. By the time he had reached the low 30s, the RTs had punched the ‘staff assist’ button and the fellow physician had come running, clearly stepping into the directing role. It was she who rechecked the RTs’ vent settings, assessed the patient, and who ultimately would have made the call had more drastic action been needed. This time, the patient’s O2 sats finally trickled up to a comfortable 95% with no further intervention, but I was left wondering about the emotional dynamics of the situation. Were the RTs thankful that ultimate responsibility was not expected to rest on their shoulders, or were they sometimes resentful, feeling that they had more depth of respiratory care knowledge? And how would it feel, how will I feel, to be the fellow physician in that moment, knowing that I am responsible for confidently and expertly handling such critical situations? I certainly don’t feel prepared now, but with the amount I am learning every week, I know I’ll be ready one day. And if time keeps up its current break-neck pace, that day will be here before I know it.