Looking Down

Today was my first experience as a house officer with hierarchy.

I have been newly trained in carrying out DC cardioversions. The procedure where a defibrillator machine is used to shock your heart from an irregular rhythm to a regular one. 

This is usually done under anaesthesia. 

This wasn’t my first DCCV procedure. Me and a PGY2 house officer walked into the theatre and waited for the patient to be put to sleep. The pgy2 has never carried out a DCCV before. The anaesthetist, a tall stranger walked up to us and immediately turned to the other house officer, looking expectantly for an introduction. 

I spoke up and introduced myself as the cardiology house officer who will be carrying out this procedure. The other house officer introduced herself. Instantly, the anaesthetist’s eyes narrowed. But it disappeared quickly and I wasn’t sure if I had seen it.

He said okay then went back to putting the patient to sleep. A few moments later, patient still not asleep, the anaesthetist turns to me and says “who do you call for help?” 

I told him I would call my registrar. He asked for their name. I gave it to him.

A few moments later he instructed a nurse to ask me to write my registrar’s name and phone number on the whiteboard in the theatre “just in case”

The temperature in the room dropped fast.

I did as I was asked.

The patient was finally asleep and I delivered a single shock to the patient’s heart. I then began analysing the rhythm. 

The anaesthetist quickly interrupted me and asked if I was happy. Well Mr. Anaesthetist, I was not in fact happy as the rhythm was still slightly irregular. I was just discussing this with the other house officer when he began taking monitors and oxygen masks away from the patient, and essentially packing up. 

I still thought the rhythm was irregular. I voiced that I wanted to deliver a second shock to the patient. The anaesthetist gave me a look and told me I should really call my registrar if I’m having “trouble”. Ie he was not going to start again and anaesthetise the patient.

I called my registrar and she said she would come up but agreed that the patient should have a second shock.

I told the anaesthetist this and he said “you shouldn’t shock her on this rhythm”. Funny how you’ve made that conclusion now instead of straight away. 

I was wondering what I should do when he said “if you’re having trouble you should really call your registrar to come and review this patient”

He then proceeded to leave. 
The patient did not end up getting a second shock. Luckily for her, her heart reverted back to a regular rhythm later on.

But I was annoyed.

Mostly with myself because I had just let another doctor make me feel small and incompetent when what I should have said was “this isn’t my first DCCV” and asserted what I know.

But I didn’t expect to run into this problem. As house officers you’re the bottom of the ladder, sure. But for someone to outright assume that I don’t know what I’m doing and make that very clear to me is just not on.

You hear a lot about hierarchy. And I’ve experienced it as a student. But this was my first experience as a house officer when I’m actually NOT incompetent at this particular procedure. 

If you look down at someone when you’re at the top of your game, forgetting that you were once at that level and still learning….. well then you haven’t learnt anything really. 

Learning point for me is to be more assertive when I know I’m not incompetent at something. And to not treat anyone else like that. 

Some people are just shocking. Would rather be in the dark ages. 

Can he just not, step on my gown. He needs to calm down.

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