I came to fellowship to learn. But, unlike kindergarten through medical school, in residency and fellowship ~97% of your learning is done on the job, rather than in the classroom or the library. In a lot of ways, I really prefer it this way. I learn better on my feet and get to make some impact on the real world while doing it.
Many (if not most) jobs have some element of on the job training, but few can claim to be as high-stakes as pediatric critical care. As a fellow, I am not just job shadowing. I am given increasing amounts of responsibility and autonomy as I progress from newly graduated resident to soon-to-be attending physician. There is some strategic planning to our progression but, sometimes, we are thrust into an unexpected situation, weighed in the balance, and found wanting.
Today a patient abruptly took a turn for the worse, my supervising physician was not immediately available, and I was left to deal with the situation. I didn't know what to do. I found myself in an unfortunately familiar situation of knowing many things that I shouldn't do but not able to think of one thing that I should. My supervising physician did eventually arrive and fix the situation. Observing the solution and understanding the rationale was incredibly educational. I doubt I'll ever forget the things I learned today, but I'm not sure if I'll ever outlive the shame of not fixing this kid faster or of letting down the nurses and patient's family who looked to me to provide answers and reassurance, to only find a confused and useless doctor waiting for back-up.
I am here to learn. I do not know everything yet. Days where I learn important lessons are good days but that doesn't mean I'll feel good through the process.
TIL: Know the physiology of every patient you are taking care of, even if they are relatively stable at the moment. This is sometimes no small task and will take valuable time from other more pressing duties. But you cannot rely on having the luxury of time to logic your way through complex physiology when things unexpectedly go south on a previously stable but complex patient.
If a patient has pacing wires and suddenly has an inappropriately low heart rate, turn the pacer to a mode that will provide an appropriate heart rate. Seems obvious when I write it down, but it's very tempting to riddle through a weird arrhythmia that seems to be partially conducting and could be related to... blah blah blah blah. Doesn't matter. Fix the damn heart rate, eliminate that part of the equation so you can move on to the next steps in stabilizing the patient.
Never hesitate to press the emergency button to get help to your room. When you have an extra body at the bedside (now that you pressed the emergency button) send them to physically find the help you need, rather than relying on texting, phone calls, etc. More generally: delegate tasks so you can focus on fixing the patient.
Just because you've found an intervention that is working, doesn't mean it is the best course of action anymore. Continually reassess.
And lastly, I am finally at a point in my training where I should not expect that just because someone else in the room is more senior than me, that I shouldn't take control of a situation. Part of my training is how to lead a team and manage a chaotic room. Someone might be a stellar seasoned nurse, but that doesn't mean they are going to steer me in the right direction for what to do in a crisis.
