I am so not ready to qualify as a doctor

I volunteered to help out for a Professionalism study which consists of 2 parts. Did the first part last year where it was only a small group discussion about what we thought about professionalism. I went for the 2nd part today which was held at the Simulation Centre at Aintree Hospital.

I went there with an open mind, not expecting anything, in other words, haven't prepared for it at all. When I reached there, I was given a tour of the simulation A&E room with everything from laryngeal airway masks to cardiac defibrillator which I could use. I was also introduced to Tom, the really high tech mannequin which is almost life-like who has pulse, breathing, etc.

I was then asked to wait outside till they set the place up. Wasn't even given a hint of what scenario that they'll put me through. Then the dreaded moment started. I was asked to go into the room. I had a nurse and a health care assistant(HCA) at my dispense.

My patient came in with asthma attack, couldn't complete sentences in one breath. I was like....sei loh, what should I do first?

The only thing which I could remember was ABC. So, I introduced myself as the doctor, asked how was the patient feeling. He said he couldn't breath and asthma. So I assumed that his airway was okay for the time being as he could still talk. Next I asked my HCA to set up ECG and pulse oximetry, the nurse to do ABG and bloods.

Then I thought it will be a good idea to listen to his chest. Ok, still got breath sounds. Sats came up to be 99%, so I could relax a bit. Then I was thinking...what's C again? Oh ya..circulation. Let me feel his carotid pulse. Tried to time it as well.

Ring! Ring! The telephone rang and I just asked the nurse and HCA to monitor the obs and just give me a shout if they started dropping. Ok, the pathology lab rang, gave me the ABG results which I copied down. Then I was looking at the figure...I cannot remember how to interprete this and what was the reference range again? Looked at it for 15 seconds and the HCA told me that the sats has started to drop. I was like...ok...let me abandon this ABG. Patient's situation is more important. Asked the nurse to set up nebulised salbutamol.

Was asked what dose to give....Ok...cannot remember so I asked him what is the usual dose. Ok. Give 5mg nebulised salbultamol.

Nurse gave the nebuliser, I was wondering how fast is the effect of salbutamol, and then the sats started to dip further. What should I do now????

Let me listen to his chest. Eh??? No breath sounds on the left. Since I cannot assess expansion on the mannequin, I asked the nurse how was the chest expansion. He told me there was none on the left.

'I think this is tension pneumothorax, could you prepare the needle for me to decompress it?, I wasn't even sure what sort of needle do they use, what colour. Was it the 2nd intercostal space midclavicular line?

By that time, the oncall anaesthetist ran in. I told him that I suspect that the patient has tension pneumothorax which he examined and agree with me. Then he said we had to get a chest x-ray first before he could stick a needle in. The HCA called the x-ray department and they said there'll be a 20 minutes wait. I was like....'I think we should decompress the pneumothorax before ordering the chest x-ray as the sats is dropping really quick now'.

Then I realised that I had been referring to the wrong side of the patient and the anaesthetist was going to puncture the wrong side. So, I quickly corrected myself and luckily he listened to me and deflated the correct side. Phew......then he asked what should I do next, I went...I don't know but I think we should get the chest x-ray done.

'That's the end now.', I was so relieved when the nurse told me that it was over. Next was the most painful part, to watch the whole video recording of what I'd done for the past 15 minutes and I had to comment on what I was thinking at each point in time.

I don't know if the supervisor was trying to make me feel better but he said I did well and not many of the previous candidate detected the pneumothorax. It was truly an unforgetable experience for me being placed in such a stressful situation for the first time, handling everything on my own. I was actually glad that I was given a chance to experience this when I've just started my 5th year. I realised how inadequate I was and I had better study harder and get the basics of emergency management drilled into my brain. I really have to learn how to interprete those ABGs as well! So much for ordering them and not knowing how to interprete it. Useless me!

Luckily it's not a real patient. I wonder how would I have felt if I'd killed a real person. Don't want to even go near there.