Déjà Vu

Abstract

“Respiratory distress. Four minutes out,” crackled the radio. Terrified, I walked over to the resuscitation bay. It was my third day as an intern. An elderly man came in puffing away on BiPAP. His frail chest heaved about forty times a minute. My chief resident nudged me to the head of the bed and told me to get set to intubate. The laryngoscope felt foreign, an intrusive metal object I was being told to jam into someone's throat without breaking teeth and somewhere in that mass of tissue to find the “pearly whites.” The room was a blur around me as equipment was set up, meds were drawn, a ventilator was acquired. My chief, placid as a lake, told me to call for my meds. As the paralytic went into the patient, I felt its effects on me. I felt like I was the one suddenly unable to breathe or move, not the patient. I placed the laryngoscope in the patient's mouth and tried to get a view. The laryngoscope seemed to resist me, as I was afraid I would rip off the jaw with too much force. I told my chief I had no view, the saturation was 90 percent. He took over and had me stand at his right shoulder. He got me a grade I view and cried, “There, see those white things? Put this tube through there.” I did. As he and the attending congratulated my first intubation, I wondered if I'd ever get better. Early July, I was working a shift in the emergency department as the senior resident. I sent my intern in to see a patient being dropped off by the paramedics on BiPAP. He looked terrible, with impending respiratory failure. I asked my intern what she wanted to do. As she thought, the nurses and I had a conversation with just a glance. They drew up meds and called respiratory. As my intern decided that the patient needed to be intubated, we were all set. She got set up with me at her right shoulder. As we paralyzed the patient, she went in with the laryngoscope. The patient began to desaturate and we hadn't quite gotten to the epiglottis. I squeezed past her as we swapped places and bagged the patient up. I took over and managed a grade I view and showed my intern the view I was looking at. Much like my chief had two years ago, I cried, “Put the tube through those white things!” After we left, my intern turned to me, and far more forthright than I was at her stage asked, “Does it get any better?” I chuckled as the déjà vu hit me. I told her this story and how all it took was two years and about a hundred intubations before I had switched sides in this position. It reminded me of the light beyond the tunnel, the incredible journey I've made in the long shifts and the short days that separated those two experiences. It reminded me of how it felt to be terrified, and excited, anxious, and exhilarated all in one, feelings I now begin to feel all over again as I look forward at the next change in roles this July as I'll be the attending standing there watching and trying to let my residents learn and teach, all the while internally worried that the buck stops with me. I'm sure I'll look back with as much fondness as I watch my new senior residents teach my new interns and recall how amazing each step of this journey has been.