Not long ago a classmate and I were told that there was a patient who needed his chest tube removed. The intern said one of us would do it. Initially I was going to do the pulling. But it really didn’t matter. Neither of us had ever done it.
Before we reached the patient’s room, our intern verbally walked us through the steps we needed to do in order to safely remove the chest tube. After all, you don’t want to be giving instructions at the bedside while the patient is awake and afraid.
It turned out the patient was very afraid. He had just experienced having a chest tube removed a few days ago. For reasons I was not familiar with (as I had never met him before and never looked at his chart), he had required a second chest tube. Now, though, it was time for the second one to come out.
As I bent over the bed cutting off the sutures the patient continued to express his fear. It had been very painful the last time it was done. He also wanted to make sure that we waited long enough for the pain medication to kick in (he had received some IV pain medication from the nurse right before we came in).
I finished cutting the sutures and the patient looked at me and asked if I had ever done this before. For a split second my mind froze. I didn’t want to say no. But it is bad form to lie to a patient. After gathering myself, my answer came out: “You’d be surprised. This is actually fairly common in the hospital.” At this point my classmate chimed in that chest tubes were fairly common and it was pretty routine for them to be taken out.
It worked. The patient seemed to find comfort in the fact that his procedure was simple — and in the process he appeared to move away from the question he initially posed of whether or not the two medical students in his room had ever done the procedure before.
My classmate ended up pulling the chest tube. The patient was actually quite happy about the whole ordeal; it hurt a lot less than the previous one. He even said that he wanted us doing his chest tubes next time he needed one pulled.
The way I answered my patient when he asked if I had ever pulled a chest tube was not something I came up with alone. I actually heard of it from a pediatrics attending physician. She recounted a similar incident that occurred to her while she was in residency. She told us that the patient looked at her and asked her if she had ever done a procedure before. And her answer was, “You’d be surprised how many of these I’ve done.”
By the very nature of medical education, there will always be a patient who is our “first.” Our first intubation, our first blood draw, our first whatever. Sometimes, we have to, as my attending told us, “fake it” until we make it. That’s the only way we can learn.
And for those readers who are not familiar with medical education, this may sound terrifying. But the intern, who had pulled many chest tubes, was by the bed when the time came for the pull. Should something have gone wrong, we were being supervised.
