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The Ability to Intervene
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By Lorelle Knight
TCEP Medical Student Board representative

Last week I found myself in an afternoon lecture without coffee. Fetal heart monitoring graphs would have been interesting if I'd had enough caffeine in my system or if I'd not just come off of OBGYN night shifts, but in that moment, I was having a difficult time paying attention. At some point, the lecturer began talking about umbilical cord prolapse.

"If you're on an airplane, and they call for a doctor because the pregnant woman three rows back says her water broke, would you know what to do?" He then described cord prolapse with vivid detail. "What if this were the scenario?"

That was all it took to get my attention. Like so many of my peers, my route to emergency medicine claims the same starting point as my route to medical school in general: the simple question, would I know what to do? At some point we read a news article, saw a TV show, or -occasionally- witnessed a real-life scenario that made us ask ourselves that question. And whereas others might say "sure; I'd call 911," that wasn't enough for us. What if you can't? Or what do you do in the meantime?

If a woman on an airplane has a sudden cord prolapse, you elevate the presenting part of the baby off the prolapsing cord. You don’t move your hand until the patient enters the OR for a C-section. I learned that last week. I made a point to remember it so that if I were the doctor on that plane or the provider in the ED when it happened, I’d know how to respond. The thought of being able to provide an intervention –even one as simple as running an EKG when no techs are available– motivates me because it answers that one simple question.

So I try to remember to reach for the bottle of vinegar after a jellyfish sting but to turn on hot tap water after a stingray’s. I embed in my brain the clinical signs for a needle thoracostomy in the trauma bay and memorize that I’d immediately give esmolol and nitroprusside if an ascending aortic dissection pops up on a CT. One of the beautiful things about medicine is that there seems to always be another intervention to learn. There is always something else I can become capable of doing, whether it's due to changing recommendations, my own progression in education, or strange, tried-and-true practices that I’m just now hearing about (read: hair apposition for scalp lacs).

Like so many of my med school peers, the ability to intervene and to stop downward spirals from turning into terrible prognoses is what drives me. The desire to know what to do and how to help is what got me to medical school, and it’s what sent me on my path toward emergency medicine. Even now, it’s enough to wake me up from an un-caffeinated afternoon slump, and I have to say, I’m incredibly grateful for that.

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