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Intubation Made Difficult

It was a Friday afternoon in the middle of October during my second year of medical school. I, along with my classmates, was preparing to complete our formal graded “check-off” for intubation. Like prisoners awaiting their sentences, we lined up to partner with the intubation dummies, which were plastic upper body models with fully exposed lungs. It would be logical to think that these half-humans would be anchored to the table they were placed upon, but alas, they were not. It would also be reasonable to assume that supine upper bodies would be difficult to intubate since they could freely slide across the table during the process. It was, and they did. So there I stood, the youngest of all my classmates, un-scarred by experience but determined nevertheless.

Laid before me, I had a variety of prison shanks and their respective curved and straight miniature machetes. I remembered that these prison shanks are also called blades named after Mac and Miller, who were either the two doctors who invented the blades or the two unconscious patients who had to endure them. Nervously, I picked up the straight machete, bent over my poor, undeserving dummy, and opened his mouth. With my left hand gripping the blade and the other hand holding his mouth open, I went spelunking in the cave that was his oropharynx in search of the mysterious vocal cords.

At this point in my journey, I had finally found the hermits known as vocal cords and even had my machete at the right place in the back of his mouth. This was when I was supposed to pull forward “in the direction of the patient’s (imaginary) feet,” which was just a professional way of saying “don’t pull upward and break his teeth.” Here is the part where I should mention that in that moment, I had about the same amount of upper body strength as a fully cooked plate of spaghetti; not even al dente but fully cooked. I pulled and pulled and pulled.  Nothing happened, except that I gave my dummy a need to visit a dentist. I imagine that I looked like a linebacker with the staggered stance and game-day grimace. However, in contrast to a football player, I had no strength and no leverage as my arms were too short to use the blade and employ my elbow as a fulcrum at the same time. So, unfortunately for me, my leverage was nonexistent, and my fulcrum was imaginary.

There we were; me, two of my classmates, and one faculty member who was obviously sympathetic and amused. Well, he had finally seen enough. Not to mention that if this were a real patient, I would have completely ripped through his vocal cords causing him to be mute and myself to be sued. He told me to switch machetes, I mean blades. This time, I picked up the curved one. Imagine the weapon that the grim reaper wields when he comes to take away an unlucky soul. I had a smaller version of that. I repeated the entire grueling ordeal over again to no avail. At this point, it was I who needed to be intubated because I was out of breath and soaked with sweat and defeat.

I forgot to mention that during the entire ordeal, there were two photographers taking pictures for the school’s new recruitment pamphlets. They decided not to focus on the other people who were successfully intubating their fake patients. Instead, they made me, the tiny, twenty-one year old girl who looked like she was struggling to deliver a baby from the wrong end, the focal point of their portraits. To anyone who wishes, I can send an autographed picture of myself on the school’s fall flyer that is captioned: “If You Never Lift Weights, Don’t Intubate.”

Meredith makes this intubation thing look easy on Grey’s Anatomy, but trust me, it was hard work. The faculty member, who had apparently been holding out on me the entire time finally got the hint about my miniature, size-five-surgical-glove hands and strength or lack thereof and rushed to grab an even shorter version of the sickled symbol of certain death. I am Type A by birth so failing was not an option. With my friend stabilizing my half-bodied victim, and the faculty member propping open its mouth, I tried again. Slowly, but surely, I swept the laryngoscope from right to left correctly moving the tongue in the process. All the while, I was praying for mercy but mainly strength. Ah! Finally.  There they were: visible, pink, and oh so beautiful. They were the gates of heaven, and I, as the grim reaper had finally brought the right-sized instrument of morbidity to be allowed entry.

Next, I slowly and carefully slid the endotracheal tube past the lips, teeth, and tonsils and through the pearly gates into a pre-pulmonary paradise. I removed the stylet added the capnograph and the bag valve mask. It was the moment of truth. With my eyes closed, I slowly inflated the bag valve. Cautiously, I opened my eyes. Glory hallelujah!  Both lungs inflated equally which meant that I had not trespassed into the right main bronchus. Dripping with sweat and embarrassment, I wiped the failure off my brow. A classmate made sure I had verbalized everything on the check-off list because it was time to go in front of the professor who would grade me on this live-saving, energy-draining process.

I should have waited until a later date when I knew what I was doing or had developed my biceps. But of course, my impatience outweighed my desire for perfection. I walked into the check-off room exhausted from the practice intubation’s upper body workout. Three failed attempts equaled automatic grade failure. No pressure. With my sympathetic nervous system on maximum overdrive, I tried and failed twice.

Graciously before my third and final attempt, my professor asked if I had forgotten anything. Once again, more embarrassment dripped down my face staining my cheeks a bright, blood red.  The stylet. How could I have forgotten? For the non-medical folk out there, a stylet is like a pipe cleaner without the fuzz that keeps the ET tube from collapsing when descending through the vocal cords. I slid it through the tube, and I was ready for business. With my last ounce of strength (believe me, I was sore at this point); me, my child-sized hands, my tiny curved prison shank and my imaginary fulcrum united and finally executed an intubation for the second-ish time that day. The bag valve tells no lies, so I pressed in on it nervously. Both lungs rose and fell. A wave of salty relief rushed over my body, and the desire to ever be an anesthesiologist rushed out. I thanked my professor, who assured me that life is not all about grades, which is never comforting to hear after just being graded.

With the accomplishment of finally achieving al dente strength under my belt, I went to celebrate by sitting alone in my car. Relieved, I began by catching my breath then profusely releasing the droplets of frustration from my eyes that had gotten clogged up in my lacrimal glands because of this arduous process. All in all, my plastic patient probably would have survived minus a molar or two.

Lydia Boyette, DO, MBA (4 Posts)

Managing Editor Emeritus (2018-2019)

Campbell University School of Osteopathic Medicine

Lydia Boyette is excited to be a managing editor for in-Training Magazine. In May 2019, she graduated cum laude with a Doctorate of Osteopathic Medicine and summa cum laude with a Master of Business Administration. Lydia matched via the NRMP into anesthesiology residency at the University of Central Florida.

Throughout medical school, Lydia wrote stories about her experiences learning clinical skills and has had her work published by PubMed, KevinMD, and StatPearls, LLC.

Additionally, Lydia has spent a significant amount of time working for community health centers in rural areas. She served as a student physician ambassador for her medical school and previously held the position of editor-in-chief for the local community health clinic's newsletter.

In 2015, she graduated magna cum laude with a Bachelor of Business Administration in healthcare management and a minor in general science from Campbell University in Buies Creek, North Carolina. She also served as an English composition tutor and editor. While completing her undergraduate degree, Lydia was inducted into several honor societies including Phi Kappa Phi, Delta Mu Delta, Pre-Med Allied Health, and Who's Who Among Students Class of 2015.