Re-calculating Route
When I was younger, we went on a road trip to Scotland. It was the first time my family bought a GPS for the car. It was a Garmin, with a blue arrow showing the way. My sister and I would sit in the back seat, begging to hold it. A sophisticated lady would voice out the directions. When my dad took a wrong turn (which happened quite a lot), she would say, "Re-calculating route." We would imitate her and laugh.
The past few weeks were busy. I was falling into the monotony of life. I'd wake up, think about how long I have before I need to start getting ready, and eventually drive to the hospital listening to an audiobook. Then I'd spend the day in the geriatrics ward, reading patient notes, writing discharge summaries, and if I lost in a quick contest of rock, paper, scissors with the junior doctor- doing rectal examinations on patients.
In the Geriatrics ward, many patients had delirium/dementia and had a loose grasp of reality (one patient was convinced that I was Princess Leia. Me. In my baggy grey scrubs, dark circles, and messy curly hair barely contained in the crocodile clip). I also felt delirious at times, completely cut out from the outside world until I walked out with my coat at the end of the day.
One day each week, the third-year medical students would come into the ward for placement- their first ever time in the hospital for many. I'd teach them how to read X-rays, give them the names of patients who are likely to talk to them, and also help them practice taking blood from patients.
The procedure of taking blood involved finding a good vein in the patient, carefully inserting the needle into the vein and inserting a bottle into a tiny device called a vacutainer to draw out the blood. This needs to be done without pushing the needle in further which would rupture the vein. It is a simple procedure, but easy to fail. The procedure feels different on people compared to the rubber arms that we learnt on.
A lot of the medical students that I've taught on the ward seem nervous. I tell them that it is good that they are nervous to start with because that means they understand the pain they're about to inflict on another human being, however small it might be.
I'd talk through the procedure slowly after getting permission from the patients. Some of them succeed and some of them fail, and I'll have to take over whilst they apologise to the patient. Most patients console them and say, "We all have to start somewhere."
One night whilst I was in bed, I was wondering how my role as a tutor in that scenario affects the outcome. As realisation hit me, I woke up with a jolt, to scribble five words on a sticky note before falling asleep.
I had said these words to some students and didn't to others maybe because I was focused on the task itself, or I was thinking about the task that I was putting on hold to teach them.
"It is okay to fail."
Students were more likely to be successful when I said those words- when I told them, it is okay to fail because I am right behind them. I started religiously telling every student I taught this, along with the reasoning.
The likelihood of being successful in taking blood from a patient depends on how confident you are. But ironically, the confidence comes from not being afraid to fail. One needs to fail to both perfect technique and to build confidence.
To quote my friend JK- "Every wrong turn is the right turn." This was true when I learnt to ride a bike, when I learnt how to choose friends, when I learnt maths. Failing is part of the process and confidence doesn't mean one believes they will pass, it means one believes they will be okay even if they don't.
The success rate went up from 50% to 85%. Of course, there could be other factors contributing to this. But what I am grateful for is that the experience took me back to when I started out in medicine.
The experience helped me to refocus on what it was that I was doing. I was focusing on the task of getting blood, sending it to the pathology lab so we can monitor the patient's wellbeing and decide management. But I should have been more present in the moment. Two human beings needed me to be present in the moment- the patient and the student I was teaching. Both are vulnerable in different ways, both need to be comforted in different ways.
When we were done with the procedure, I'd get rid of my gloves and wash my hands. The student, if they succeeded, would be unable to control the joy as they waited their turn to wash up. I'd pause to appreciate the moment. I remember when I once found so much joy in something I repeated at least ten times every day now.
A few days ago, I was teaching some students in a class setting. I was teaching them to use the stethoscope to not only listen to the heart but also to listen to bowel sounds. They were practising on each other and one student, very loudly exclaimed, "WOW! I CAN LISTEN TO HIS FOOD BEING DIGESTED. HOW COOL IS THAT?"
When I was studying for my exams during the initial years of medical school, I looked up to the final-year students. I wanted to be one of them. But now that I am here, I've realised that to become a better clinician, I need to return to my foundation now and then. I was that student only a few years ago, and he helped remind myself of the magic that I became blind to the more I saw it. I thought as a teacher, I should be the compass. But I realised, whilst I had the map, the students were my compass, and helped me 'recalculate route'.
