American College of Physicians: Internal Medicine — Doctors for Adults ®


From cold feet to code feat

From the May ACP Hospitalist, copyright © 2012 by the American College of Physicians

By Wikrom Chaiwatcharayut

“Sir! Sir! Are you all right?”

A man was lying on the floor. We tried to rouse him by shouting and tapping on his shoulder. No response. We checked his pulse and respiration. His heart was still beating but he was not breathing. We then called the code and asked for a crash cart, praying for someone more reliable than ourselves to come.

The author, surrounded by fellow Internship Boot C...

The author, surrounded by fellow Internship Boot Camp students, gives the experience a thumbs-up. Photo courtesy of Mayo Medical School.

Just a few moments later, the crash cart arrived, but no hero showed up. Our struggle to save a man's life had begun. It was quite a long time of chaos because we were not used to this kind of situation and each of us was not sure what to do. Fortunately, we noticed a used needle near the man and determined that he abused drugs and had overdosed on opioids. We gave him medication. Finally, the man started to breathe again.

Of course he did! That was a simulated situation in a training workshop at Mayo Medical School for final-year medical students called “Internship Boot Camp.” It aims to prepare medical students for daily encounters they will face in the year ahead. Unlike my teammates, I am not an American medical student. I am a visiting medical student from Thailand who was lucky to be able to join the activity.

Imagine… You got into medical school. You thought you learned everything, from a small thing like a cell to a bigger thing like an organ and finally the whole human body. You also learned how people get sick and how we can treat them with medication and/or surgery. You know the algorithms for both basic and advanced cardiac life saving. You took classes practicing chest compressions on a plastic model. So are you ready to be a doctor?

No, you are not! No matter how well you did in the exam or how perfect the grades you earned, you cannot be ready to save a man's life without having seen and done it in real life. I can give you an example.

Earlier this year, as a final-year medical student, I did a rotation in a community hospital in a rural part of Thailand. I was on call and one of my patients had cardiac arrest. I knew what to do because I had just crammed the guidelines into my head. I rushed to the patient's bed and asked for a crash cart. I held two electric paddles in my hands, aiming to defibrillate the patient's heart.

All of a sudden, I stopped. I did not know exactly where to put those paddles! I could imagine vaguely that it should be somewhere on the patient's chest. Adrenaline did not help me but made things worse. An intern came in and helped me out of that panicked moment. We then tried our best to resuscitate the patient; unfortunately, she never came back. That memory is still fresh for me.

One good thing I have learned from a bad moment like that: I get to know what I don't know. After the incident, I picked a crash cart and deliberately looked at every button on the monitor and almost everything inside the cart. Then I felt that I knew it better—much better.

After I finished all my required clerkships in Thailand, I came to the United States to do elective rotations here, expecting to gain new experiences in a country that provides some of the best medical care in the world. And I've gotten what I wanted. In the hospital, I am exposed to up-to-date medical care, standardized protocols, and some state-of-the-art medical technologies. Outside the hospital, I get to learn the way American people eat, talk, and live their lives. Above all, I get a chance to improve my Thai-style English, hoping to make it a little bit more like a native speaker's.

But let's get back to the story with which I began—the boot camp. As I said, I was lucky to be allowed to fill an empty space after a student canceled. It was on my first day in the camp that the simulation of an opioid overdose took place. I still did not feel comfortable with that life-threatening situation. My American colleagues felt exactly the same. However, we got through it and somehow successfully saved the plastic mannequin's life.

That night our homework included reviewing how to do CPR. On the second, third and fourth days of the camp, we were called to a code at least once a day. We gradually became less frightened and more confident and calm. We also worked better as a team. We got to the point that even when we had to call “time of death,” we did it without any guilt or shame because we knew that we had done exactly everything we could, correctly.

It's my last day in the camp now. A nurse rushes into the room, shouting, “Could you come to see this patient? He's barely breathing.” I've got to go!

Mr. Chaiwatcharayut (Tor) just finished his final year of medical school at Chulalongkorn University in Bangkok, Thailand.


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