“Live as if you were to die tomorrow. Learn as if you were to live forever.”

What a beautiful quote from Mahatma Gandhi. Personally, I love learning.

It doesn’t matter what profession you find yourself in, you will forever and always be learning. Let me tell you, as a nurse, we are consistently and constantly learning. Last weekend, I was fortunate enough to find myself at a two day simulation based course called Base Camp at Weill Cornell Presbyterian. This course focused on pediatric airway, trauma and mass casualty emergencies, with attendance of the course including first year Pediatric Emergency Fellows, Pediatric Emergency Nurses and Child Life Specialists.

Talk about a way to tire yourself out!

In emergencies, I always find that my brain splits into three different sections. There is one part of the brain that focuses on what my tasks are. Am I the medication nurse? I need to focus on my doses, concentrations and volumes. Do I find myself at the bedside doing the primary assessment? If so, I would need to focus on my ABCs, otherwise known as airway, breathing and circulation. Another part of my brain needs to wear the “situational awareness” hat … I need to be able to know what’s happening in the room. Is there something that is effecting the safety of my team or my patient? I need to be aware of that. The last piece of my brain that is working at top speed alongside the other two pieces is the whole picture on the patient. What are my differential diagnoses? Sure, you might look at the symptoms in a kid and know instantly what the diagnosis is, but you always have to keep in the back of your mind that this could be something else. So, in any emergency situation, I feel almost like I have a superpower. It’s as if I can slow down time. I can’t really, but I need to be able to see all the corners of the room at once. Hence, why this weekend of all Pediatric emergency simulation was EXHAUSTING!

Sure, it was exhausting, but it was also FANTASTIC. This kind of training is really perfect for those of us who work in a high stress environment. The first time you are the Team Lead during an emergency, it should be in a simulation environment. That’s the time to step up and, if/when you are going to make mistakes, you make them on the plastic sim-man. I would rather learn on a simulation dummy than do the absolute wrong thing on someone’s child… on one of my patients, whom I whole-heartedly refer to as my children at work. We had full team simulations where the Fellows always took the lead, but we also had simulations that were nurse-led. I internally cracked up because the first one we walked in to, I said in my head, “Oh Maryann, you are the Team Leader now.” There is always something that can be learned in every situation and I took home so many amazing points from the weekend. I had one of the instructor’s try to be tricky and I fell for it. One of the scenarios that I was the Team Lead on was a 5 year old who fell down at the playground with positive loss of consciousness and three times of emesis. You hear this and automatically you are thinking head injury, brain bleed. He started having a sign called Cushing’s Triad, which are three symptoms that suggest a rise in intracranial pressure: 1. hypertension, 2. bradycardia and 3. irregular respirations. We followed all the right protocol, and I did my best to lead the team, even over the cries of the actor playing his dad (he was so good!). We needed to secure an airway. The “doctor” in the room, played by one of our instructors, basically tried to make our live’s difficult. No specialty services came, no x-ray, no respiratory, we were basically on our own, and on top of it, they usually pretended to not know anything. So when I asked the doctor what meds she wanted to use for Rapid Sequence Intubation and she only gave me a paralytic, I should have been concerned and asked why no sedative. There are also barriers in simulation too, but I know to never give a paralytic without a sedative first. I KNOW that, but do you think I will allow a doctor to let me do that to a patient again? No way, Jose. There were so many wonderful pearls of wisdom from the weekend… I wish I could bottle them up and give them out to my coworkers!

One particularly inspiring story came out of our nurse-led simulations. Myself and another nurse ended up going twice, which I didn’t mind, but I wanted to be sure that everyone who wanted a chance to be the Team Lead went. There was one nurse who was soft spoken, but you could tell that all her cylinders were firing during these simulations. I asked her if she wanted to be the team lead and she was hesitant at first. I told her that now was the time to do it, with a plastic simulation doll instead of a real patient and that she had us (her team) around the bedside with her. We wouldn’t let her fail. So she agreed to be the Team Lead on our very last simulation. We walk in and I think that perhaps the team didn’t know if she would step up, so there were a lot of side conversations going on. I was at the airway so I could see everything. There were people at the med cart discussing the case, and the person next to me was starting his primary assessment and saying his finds out loud but really at nobody in particular. The nurse stepped up and with a stern voice said, “Okay team, let’s all focus. I’m going to do a recap and I want to hear my primary assessment called out.” If we weren’t in the middle of simulation, I would have clapped! We made it through the simulation (just barely, it was a tough one) and everyone gave her the kudos that she deserved. I brought up to the instructors that we basically kind of forced her to be the Team Leader, and I told her that I was really proud of how she stepped up to lead. She gave me a hug as we were walking to lunch and she told me, “Maryann, I would have never thought that I could have done something like that.” I have chicken skin just thinking about it. (Side note: “chicken skin” is a lot like goosebumps, but that’s what we call it in Hawaii)

All in all, I met a lot of really great people in my field over the weekend and I was so happy to represent my hospital and coworkers as well as I could have. I even made some great connections regarding projects and possibly graduate school… we shall see what happens next!