First times are hard to forget.

They make for great stories -- nostalgicand self-deprecating reminders of who we were before we became who we are now.Medical school is the setting for many first times; stories of jittery firstblood draws, or students nodding along to heart sounds that they didn'tactually hear, are ubiquitous. However, I wish we would more directly address themistakes that can happen in these first times.

I have just stepped out of my second procedures shift in the emergency department, where I have the opportunity to practice skills like placing IVs, doing electrocardiograms and placing sutures on patients with real medical issues ranging from shortness of breath to hemorrhage. I've attended a formal training session and then conducted these procedures on several patients, but every new patient still feels like the first time for me.

I wear a false cloak of confidence each time I introduce myself as a medical student, and politely ask if a patient is willing to let me perform the procedure on them -- earlier today, it was an IV. I used small talk as a distraction from the sharp needle I was about to puncture into the patient's arm -- a distraction that worked well for both of us and further masked my inexperience.

As I drove the needle forward, I was well aware of the gamble I took -- I had no clue if there would be a flash of blood to indicate I was where I needed to be. While the anxiety burned my fingertips, I continued to coax the patient through this procedure, managing to compose a steadiness in my voice that I wished would exist everywhere else.

I found a vein --but sometimesI don't. I always make eye contact with a nearby nurse, letting the panic settlein my eyes. They confirm my successes with a slight nod or my failures with aswift take-over. I avoid eye contact with the patients, hoping they'll continueto be blind to my unease.

Perhaps that is the true skill I am learning to hone during these shifts -- "fake it 'til you make it," as they say. This makes me uncomfortable. I want the patient to trust me and believe that I know what I am doing, but do they deserve to know that I don't actually feel this way?

I am lucky that the patients I have worked with have been so encouraging of my learning process and understanding of my imperfections. I remember one patient waving off his concerned son after I could not get my IV in on the first try: "Let her learn. I feel fine!" he said, before giving me the thumbs up to try again. But I know that not every patient will be so forgiving.

The idea of "practicing" on realpatients is discomforting. When I make mistakes, the patients will have to dealwith the repercussions -- a bruise from a failed blood draw or an uneven scarfrom an imperfect suture. This lingering guilt makes the failure that much moreformidable for me. It is difficult to place my learning above a patient's needfor the best care possible; and when I ask nurses if I can perform a procedurerather than them, I feel as if I am robbing a patient of that care.

I realize that as a medical studentI will one day be responsible for patients as a full-fledged doctor, with few peopleabove me on the ladder of support to call for help. These moments of uncertaintythat I traverse through now are my investment into my ability to care forpatients in the future; I am asking the patients I see today to make thatinvestment in me as well.

Their investment is an act ofaltruism that they may not even be aware of. I wish I could repay their faithin my future self, but I can't. With each of these acts of altruism, though, Ifind the vein a little quicker, and hold the needle a little more steadily.

One day, it will stop feeling like the first time.

Stanford MedicineUnplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unpluggedcategory.

Tasnim Ahmed is a second-year medical student from Bangladesh and Queens, New York. She has a background in cognitive neuroscience and education. Her interests include global health, women's health, and embroidery (for her own health).

Photo by josh

Originally posted here:
First times in the emergency department - Scope