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Pulse Check

Midway through my internal medicine clerkship rotation, I was finally starting to feel like I had the hang of things. I was warned of the insurmountable amount of knowledge we would need to pick up, the tiring nights on call, and the constant uncertainty of our actions. But I was also told that it would be the first time I would feel like a doctor. Medicine fosters a sense of responsibility and independence that is unmatched on any other rotation as a medical student, and makes clear that your actions can directly impact your patient’s outcomes. Despite all these pearls of wisdom passed on by my classmates, I was not prepared for the overwhelming sense of awe that came over me when one specific event put all of this into perspective.

A code blue was paged overhead — the first one I had heard while on call. As medical students, we are encouraged to attend but told to observe unless asked to assist. I was both excited and nervous to see one in real life for the first time. I quickly grabbed my stethoscope, threw on my shoes, and ran out of the call room.

On the bed was a woman in her 50s looking pale and blue. No one knew exactly how long she had been in cardiac arrest. She was asystolic — not a shockable rhythm. A nurse started chest compressions as others scrambled to get intravenous access.

I slowly walked into the room to join the crowd of colleagues who had gathered to watch the event unfold. My senior resident was the one running the code, and he was calmly giving instructions amid the chaos. As he surveyed the room, he turned to me and told me to put on gloves — both my classmate and I were needed to take over chest compressions.

Reflecting back now, I know that I should have been scared. I had only ever done this in simulations, never on a real person. But amid all the adrenaline, I felt empowered. I was needed. CPR does not always work, but it was something I was being counted on to perform as I had been trained to do.

As the pulse check was called, the person in front of me stepped out of the way so that I could begin. I will never forget the lifeless face that stared back at me as I climbed onto the bed for the first time.

“No pulse!” one of the nurses yelled.

“Restart compressions!” the senior resident instructed.

And just as I had been trained to do, I began pumping along the rhythm of “Stayin’ Alive.”

A few pulse checks later, we miraculously had a pulse. The patient was back in sinus rhythm with palpable radial pulses. Fast and strong, her pulse was stable all the way through transport to the ICU.

And just like that, it was over.

After handing over to the ICU staff, I returned back to my call room to reflect on what had just happened. I had helped (if only temporarily) save a life. I felt important. I felt excited. But perhaps most of all, I felt melancholic.

It wasn’t until then that I processed that this patient’s family had been in the room watching us pound on their loved one’s chest. It wasn’t until then that I processed that she had been the first dead patient I had seen. But perhaps most sobering was the fact that I never even knew who she was or why her heart had stopped, nor would I ever find out.

At the end of the day, this experience was another small step on the path to becoming a physician. I believe that the way I felt that night is the way that every trainee will feel at some point in his or her training. The constant doubt, stress, and fatigue all suddenly vanish, if only temporarily. Regardless of the outcome, the sense of responsibility and importance that I felt in those moments was unlike anything I had experienced in clerkship thus far.

As Samuel Shem wrote in “The House of God”: “At a cardiac arrest, the first procedure is to take your own pulse.” While I didn’t quite heed his advice, this reflection serves to do that retrospectively. This surely was not the first time that I had made an impact in a patient’s life, whether good or bad. But it was the first time that I felt empowered as a medical student. I felt a sense of relief knowing that in that moment, I wasn’t a burden on the residents and staff around me. When called upon to act, my years of training and practice were finally put in place, even if in this one small way.

The winding path to become a physician has many ups and downs, as well as innumerable firsts. It may seem unlikely while you are slogging through the trenches of pre-clerkship, but there really is a light at the end of the tunnel. Regardless of how it feels at any given time, it will all be worth it in the end.

Matthew Lenardis Matthew Lenardis (1 Posts)

Twitter Social Media Manager

University of Toronto Faculty of Medicine

Class of 2016 medical student at the University of Toronto Faculty of Medicine.