… but I did stay at a Holiday Inn Express!

by girlwithaknife

There’s a first time for everything.  But no one wants to be the first patient for anything.  And I can’t blame them – I wouldn’t want to be a guinea pig for someone’s first attempt at drawing blood or removing an appendix.  Still, all those doctors and nurses you see walking around the hospital had to learn somewhere.  If you’re in any kind of teaching hospital, chances are they’ll be learning on you.

To be sure, there’s plenty of supervision, whether from attendings or more experienced residents.  That supervision is usually most direct in the summer, when newly minted doctors are being unleashed on the unsuspecting masses for the first time.  Still it’s considered very poor form to make it obvious to a patient that they’re your first.

Less than a week into my residency, I was asked by an attending to perform a fairly routine bedside procedure – changing a negative pressure wound therapy (aka wound VAC) dressing.  The dressing itself consists of a sponge which is cut to size and placed in the wound, then covered by a sheet of sticky clear plastic, the “drape”.  An attachment connects the dressing to a pump, and this applies constant suction to the sponge.

Once the pump is turned on, the vacuum effect of this contraption pulls fluid and other crud (yes, that’s the technical term) out of the wound.  It also draws the edges of the wound together.  Together, these effects help large wounds heal much more quickly.  Changing the dressings isn’t too difficult, but there is an art to doing it well – minimizing the patient’s discomfort when the old dressing is removed, cutting the sponge and drape to the right size, creating a proper seal, resisting the urge to fling the pump across the room when it won’t stop beeping because there’s an imperceptible leak somewhere in the system…  Usually, it’s a two person job, since we’re trying to customize and apply a flat dressing to curved surfaces.

Anyway, after some discussion with the attending, he was comfortable with allowing me to change the VAC dressing alone for the first time – I had done a few in medical school with resident supervision, and we had placed the current dressing together in the OR just two days before.  So, I ordered the supplies and went to Mr. H’s room to tell him about our plan.  We talked about the process of changing the dressing, and I told him that once the supplies arrived, we could proceed.  I asked if he had any questions before I left.

“Yeah Doc, are you going to do it or should I expect someone else?”

“I’ll be coming back to do it, your nurse will page me once the supplies get here.”

“Oh good, that’s a relief!  I’m so glad they’re having an expert do it.  I was so afraid they’d send up someone new who doesn’t know anything!”

Smile and nod, girlwithaknife, smile and nod – and don’t say anything stupid.

“Oh, we wouldn’t do that to you Mr. H, it’ll be just fine.  See you in a little while, bye for now!”

With that, I turned on my heel and skedaddled before he could ask any more awkward questions (or realize that he was, in fact, getting a complete noob).

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