Colleen Russell - art & science of medicine: My journey

Submitted 2022-08-09

I found this essay topic intriguing as it pertains to my experience as a registered nurse in a pediatric hospital, as well as community health nursing. Working in a teaching hospital, I have worked with countless medical students and newly graduated nurses. You can usually tell the “newbies” during an emergency event, they are standing around, frozen, with eyes and mouth wide open. These are the teaching moments that will never be forgotten.

Putting myself in the shoes of a medical student, the excitement and fear is understandable. My unit had many children with tracheostomies. A new medical student might never have seen one before, outside of a textbook. Walking into a room and seeing a child with a tube coming out of their throat is alarming. Imagine the alarms going off, seeing the pulse oximetry dropping, visualizing the child in respiratory distress, and not knowing what to do?

Call the nurse!

I cannot tell you how many times a medical student has tried to provide oxygen to a child’s mouth instead of the tracheostomy. To experienced nurses, this is funny. To brand new medical students, this could be deadly. Medical students must understand that the tracheostomy is the child’s airway. If it gets clogged, or the tube comes out accidentally, it is imperative that the medical student knows what to do. The problem is if no one tells them they might not ask.

If I were a medical student, I would request training on tracheostomy emergencies prior to providing any patient care. Every detail is important, from the several types and sizes of tracheostomies to the “age” of the trach, to the contents of the “to go bag” that should be always available. The “to go bag” is the child’s lifeline if the tube falls out or becomes occluded. However, most medical students do not think to ask about this. Honestly, most experienced physicians do not know either. I know this because I developed educational training for all medical professionals within the hospital.

As a medical student, the unknown is scary. Everything is scary. Nurses whiz by busy with patient care, their confidence is admirable. Trying to get a thorough exam on a patient while staying out of the nurse’s way is almost impossible. If you are lucky, the nurse will be patient with you and jump in to assist if needed. If you are not so lucky, you could be pushed aside, even ridiculed, by a nurse that does not have the time or patience to deal with your “incompetence.”

As a nurse, I try to put myself in their shoes. What would I do if I were the medical student and I walked into a room with a patient that had a tracheostomy? Hopefully, I would have been trained in tracheostomy emergencies so I would not panic. Every time you see a patient you are assessing them. When I enter the room, I am looking at the child first, not the monitors. I scan the child over for signs of distress; change in color, increased respiratory rate, the look on their face. Even the smallest child can have a look of sheer terror when in distress.

I see that the child is retracting and appears pale. The child glances over with wide eyes and a look of panic. I can hear the secretions in the tracheostomy that need to be cleared. The nurse comes in to suction and the child responds well. As a medical student, I observe the nurse suction the child but do not intervene. Suctioning was not part of my training.

The nurse walks out and I look back at the child to continue my assessment. After a deep cough, the tracheostomy tube falls out and is laying on the floor! I cannot put that back in, right? I do not know. Next to the bed is a clear bag. The “to go bag”! I learned about this from that amazing class taught by Nurse Colleen.

I grab the bag and empty the contents. A replacement trach is ready to be inserted so I slide it into the hole in the child’s neck. I give the child a few blows of oxygen with the bag already equipped to attach to the trach tube. The nurse did an excellent job preparing the room for a patient with a trach, I am not always this lucky. The child recovers completely, it is as if nothing ever happened.

But something did happen. That child completely lost their airway, and I was the only person at the bedside. That trach tube, lying on the floor, was the child’s lifeline. All the “what if’s” come pouring into my mind. What if I had not been educated on trach care, especially in an emergency? What if the “to go bag” was not stocked and readily available next to the patient? What if the oxygen was not properly set up? Even with training I almost forgot to remove the center piece of the trach that guides during insertion. It would be easy to forget to remove the guide, which occludes the hole. Such a small miss would prevent any air movement and suffocate the child.

This is an experience that will never be forgotten. The fear that sets in when a patient is in distress, followed by the fear of what to do and, more important, what not to do. I am thankful that I was previously trained for such an emergency, but most medical school students were not. I will hold onto this experience and share my story for others to learn from. I will also always check that proper equipment and supplies are readily available for every patient. Every time. I can write all the orders in the world but will always personally check the bedside. Orders from a computer do not help in case of an emergency. I also know how to stock these supplies myself if something is missing. Nurses are busy and might not get to it right away. This, in turn, will help the relationship I have with the nurse.

Overall, this experience will improve future patient outcomes and my skills as a medical student.