Blurry ECGs on exams would drive me crazy. You can’t see the boxes, let alone count them. Is that a P wave or just a smudge? Ugh, you have got to be kidding me.
I mean are they really trying to see how many times these exams could be photocopied before you can’t see anything at all? For god sakes, just make a new one at some point.
What’s worse than blurry, smudged ECGs? Trying to suture on a banana. We started out with oranges and bananas, and it would drive me bonkers. Then I graduated myself to pigs’ feet because everyone said they were really good. They were terrible. I spent hours and hours cutting and suturing pigs’ feet because although terrible, they were the best thing I could find.
It wasn’t anything like living human skin. You put a stitch in the pigs’ foot and it rips right through. The foot rolls away from you and onto the floor. Yuck! Humans don’t roll away!!!
This was ridiculous and I couldn’t wait to get to work on real skin where it would be so much easier.
Right?
I remembered this last week as I was working during an abdominoplasty and mastopexy on the same patient. We had two PAs and a surgeon working. My job was to close everything while the other two did all of the dissections. Here I am on a standing stool, leaning over on one foot, balancing while suturing 70+year-old skin, and trying not to wind up in the anesthesiologist’s lap.
The funny part is that this wasn’t an unusual situation. I’m an expert at suturing under terrible conditions. As the PA, you almost never get to stand in the optimal position. It just doesn’t happen. You’re expected to do just as good work as the plastic surgeon while you’re standing on one foot and with one eye closed because your view is blocked. By now, I can just about put the stitches in blindfolded while suspended from the ceiling, but that isn’t the point.
The point is that it doesn’t get better. It’s different, but it isn’t ideal. The needle driver sticks. The nurse gives you the wrong needles. The ones that dull almost immediately, and you have to work with it or incur the wrath of the angry circulator. The scissors don’t cut, but just kinda chew through the suture. It still happens.
Here’s the deal. Be as prepared as you can, and then work with what you have.
Maybe a more relatable example.
When you’re in middle school and high school, you hear about this magical place called the teachers’ lounge. You’re sure that in that room there is candy and soda and puffy clouds to sit on. The walls are most likely gold plated, and the air conditioner works.
The reality is that there is one old couch from someone’s house, a card table to eat on, and a refrigerator filled with moldy old lunches. Oh, wait, there is a coffee pot that even the mice think needs to be cleaned.
It isn’t always greener on the other side of the fence.
Back to ECGs…
I remember looking at charts when I first started in practice. I’d pull the patient’s chart and flip through it before surgery. I used to really like cardiology, so I’d take a peek at the ECGs and you would not believe what I saw.
Horrible illegible faxed copies of ECGs that you could barely read. I mean these had big black streaks through the whole page from the fax machine. They were a total mess. I could not believe it. Be as prepared as you can and then work with what you have.
What’s the moral of the story?
Work with what you have. Stop making excuses and dreaming about “someday.” Make it work today with what you have. You never get to choose the cards in your hand. You have to play the hand you’re dealt.
Same thing as you get ready for you the Big One. You don’t really know what’s coming. How up to date are the questions? How specific will they be? How much detail?
Do your best. There are guides and clues. There is the blueprint. There is a lot you do know. You can be prepared even though the situation won’t be ideal or perfect.
Use The Final Step to help get prepared for your exam, and then, when you get there, breathe easy and work with what you have.
Brain Wallace