As I begin my first day as an intern in the ICU, a nurse I’ve never met greets me with a harried “Doc, the patient in Room 2 is bleeding.” I don’t know who the patient in Room 2 is, much less what to do if she is in fact bleeding, but I follow anyway. My list tells me the patient is a 30-year-old female with Osler Weber-Rendu syndrome, or hereditary hemorrhagic telangiectasia, a genetic disorder that causes malformation of blood vessels. Peeking past the curtain, I see her, a young skinny woman calmly sucking on a Yankauer tube attached to a container rapidly filling with bright red blood. 300 cc in less than three minutes, per the nurse. I am such a new, inexperienced intern that I actually pause for a moment to wonder if this is enough blood to be concerned. (It is.) I am quiet for too long because the nurse taps my arm impatiently. “Doctor! What are you going to do?”
So I page my attending, “Room 2 is bleeding. Can you take a look?”—in the way that you try to convey enough urgency that they arrive quickly but not quite so much that they think you’re histrionic. As it turns out, I was dramatically underselling because the attending takes one look and says, “We need to intubate stat.” Oh.
My attending wisely does not let me attempt intubation. As I watch him struggle to place the tube, a distant part of me registers that the steady beep of the heart monitor has turned fast and shrill. There is a blur of activity as the nurse feels for a pulse, slams the code blue button, and starts compressions.
As I stand there, considering how the bed is too high for me to lean over and help with compressions, I feel a familiar sense of uselessness and of being in the way of the people who are actually helping. It’s a feeling intimately known to every third year medical student who is tagging along on rounds they don’t understand or bumbling through an OR, trying desperately not to touch anything blue. I remember when I was a first year medical student, and I viewed those third year students as knowledgeable and experienced —so much more like “real doctors.” Then I was that third year student, feeling clueless while viewing my residents as knowledgeable and experienced. And now here I was—that resident—standing uselessly over the head of the bed watching a stream of blood flowing so rapidly out of my patient’s mouth that it might have been comical, if it hadn’t been so terrifying.
The code lasts less than five minutes. As the team stabilizes the patient, my attending asks if I’ve ever placed a central line. “Once. Last week.” I do not mention that I had had to be reminded how to gown up, that I had long since forgotten how to instrument tie, or that I had sweat so profusely, my glasses had nearly slipped off my nose and into my sterile field.
“Place one now.” He teaches me again, and my hands shake so badly, I almost stab him with the needle. But the line goes in and we are on to our next patient.
There’s a ubiquitous phrase applied by higher up physicians to every student or resident experiencing that moment of uselessness. “Fake it ‘til you make it.” It’s repeated in medicine ad nauseam, and though I had heard it innumerable times before, I don’t think I understood it until intern year. It’s perhaps less comforting to hear as a patient, but for us struggling just to make it through our first day on the unit, it’s nice to be reminded that our medical journey is a process and progress is not always linear. The next time I was in a code, I was actually able to help. The next time I placed a central line, I did it without instruction. And then I started radiology residency and once again found myself knowing absolutely nothing but how to fake it.
I asked a medicine attending once, exasperatedly, after a particularly difficult case, when on earth I would finally make it. He turned to me with an eyebrow raised and said, “If you ever find out, you let me know. Because I’m still faking it.”
