Okay, one more Blink-related post (see previous post for introduction to this text). Gladwell seeks to examine the role of snap judgments in the setting of difficult police encounters. He explains that “in interviews with police officers who have been involved with shootings, these same details appear again and again: extreme visual clarity, tunnel vision, diminished sound, and the sense that time is slowing down. This is how the human body reacts to extreme stress, and it makes sense. Our mind, faced with a life-threatening situation, drastically limits the range and amount of information that we have to deal with” (224). However, one can only hope this is how we react to extreme stress. “Dave Grossman, a former army lieutenant colonel and the author of On Killing, argues that the optimal state of ‘arousal’– the range in which stress improves performance — is when our heart rate is between 115 and 145 beats per minute…’after 145’ Grossman says, ‘bad things begin to happen. Complex motor skills start to break down. Doing something with one hand and not the other becomes very difficult…at 175, we begin to see an absolute breakdown of cognitive processing…’.” (225). The absolute breakdown of cognitive processing, what could be more petrifying? As a future ER physician the ability to remain composed, to filter unnecessary outside noise, to perceive with visual clarity and achieve “the optimum state of arousal” is essential to success. It is essential to saving lives. I began to evaluate my own personal abilities in this arena. I have been told by friends and family that they admire my ability to stay calm and focused when the energy of a situation is heightened. But what situations have I truly experienced in which these skills have been properly tested, especially clinically? Shockingly they don’t leave medical students in charge of life-threatening situations too often. Yet, I wondered if I’d had a taste of optimal arousal at 115 – 145 beats per minute during a challenging situation. I guess you could say I’ve had a small glimpse.

It was my third rotation of third year. On our first day of our elective anesthesia rotation my friend and I met with the clerkship director who told us “this rotation is whatever you make it, no one would notice if you weren’t here.” As a fourth year student those were be the greatest opening comments one could ask for, but as third year students my friend and I were hoping for more guidance. This was our first lesson in truly becoming self-directed learners as we shamelessly harassed the anesthesiologists and CRNAs to let us intubate and be involved in interesting cases. Receiving even a molecule of attention was the most difficult part of the rotation — with the exception of the days we chose to practice IV placement with our favorite pre-op nurse, who was wonderful. Each day I would remind my friend that we essentially pay $200 per day for medical school, and I wasn’t going to leave until it was a “$200 day.” For weeks I honed my procedural skills, focusing on beginning to feel competent intubating in a controlled setting. It was my last day of the rotation and I had worked up the chutzpah to ask to do the airway for a case being run by a particularly…intimidating anesthesiologist. I walked in the operating room to find the following cast: a CRNA who had yelled at my friend, the intimidating anesthesiologist (she was migrating from room to room so I didn’t expect her to be there), a notoriously medical-student-unfriendly surgeon with his arms crossed, one of my other colleagues on her surgery rotation, and what seemed like an excessive amount of technicians and nurses. Heart rate climbing — at least 100 beats per minute. “You only get one shot, I don’t have time for this,” remarked the surgeon. Now I was probably around 130 beats per minute. I steadied myself behind the patient’s head with my hand gently upon the non-rebreather mask. I preoxygenated, the anesthetic and paralytic were administered, head-tilt-chin-lift, carefully I scissored open the patient’s mouth and place the blade inside. The patient was stable but I was on the surgeon’s clock and the anesthesiologist’s responsibility. I had placed the blade too deep and I knew it. “I don’t see the chords just yet,” I stated calmly. I could feel the tension build as the CRNA and anesthesiologists hovered behind me. “I’m just too deep, I think I know how to adjust”, I said, seemingly ignoring the surgeon’s “you get one shot” declaration. Extreme visual clarity, tunnel vision, diminished sound, and the sense that time is slowing down. To some degree, I felt this — the whole room was watching, but my world was entirely centered on the intricate anatomy of the patient’s airway. I readjusted the blade up, visualized the chords and slid the endotracheal tube into position. The CRNA listened for breath sounds as I watched watched the CO2 waveform on the monitor and the end tidal CO2 detector change color. “Alright good,” the anesthesiologist remarked as she relinquished a fraction of a compliment with a palpable reluctance. I left the operating room, and met my friend as I was grabbing my bag. “You’re heading out? I guess it was a $200 day?” “It was.”  

All rights reserved ©

Source:

Gladwell, Malcolm. Blink:The Power of Thinking Without Thinking. New York, NY: Back Bay Books/Little Brown and Company, 2005. Print.