I wrote this almost four years ago, a timid senior nursing student trying to branch out from my pursuit of psychiatric nursing. Recently I took the re-certification for ACLS and laugh reading this as I still felt many of the same jumbled emotions. Real codes and the processes and pharmacology are more familiar to me now. I can decipher a first degree from a third degree block and the motions and drugs and differential diagnoses now come easier. Easier but not easy. At that moment three years ago I would not have imagined myself a critical care nurse. Not in my wildest imagination. If memory serves me right I left that first day almost in tears, convinced I did not have what it took to master skills at that level. If I have learned anything in these beginning years it is a stronger self awareness that I am a victim of my own doubts. Perhaps that taunts all of us. I can’t say. Stepping through the fear to the unknown is a risk. This class was one of the first times I took a leap through fear to do something that challenged me. I have made a commitment to continue to take those steps despite the risk and the fear that they hold.
“Your patient is a 58 year old male presenting with chest pain 8/10, pulse is 190, BP 80/70 and respirations of 40,” the instructor said. “Suddenly he snorts and collapses; you see this rhythm. What do you want to do?”
I swallowed and looked down at the pasty plastic face of the mannequin and watched as little black lines squiggled their way across the EKG monitor with an impending sense of doom. Somebody call a code, I think I’m having a heart attack! SVT, V-tach, PEA, Amiodarone, Adenosine, Atropine…my brain raced through a jumble of names and acronyms and symptoms and algorhythms. Just like a TV medical drama, the world suddenly seemed to move in slow motion around me. The sound of my own heart thundered in my ears. I was running my first simulated major code!
For the first three days of Christmas break, I decided to tackle the challenge of ACLS certification. I signed up for the course eager for a chance to learn more about EKG interpretation and to practice more advanced nursing skills. I was not disappointed. The challenge on day one was absorbing a mountain of information and forcing myself to sit still for the better part of 8 hours. After deciphering what must have been miles of rhythm strips, I was still at a loss to identify runs of PAC’s from third degree heart block. I left, slightly disheartened (pun intended) with rhythm strips and terminology scrambled in my mind and all over my notebook. I had even drawn a bundle branch block on the back side of my hand when the margin of my paper was full.
As we settled into day two, things picked up. We were no longer sitting in desks and squinting at squiggly lines on graph paper. No, this day we would practice! I was eager for some hands on learning, that is, until I was I was handed the leg of a mannequin and told to pick up a drill. I stared at the large bore needle and again at the leg…this was going where? Don’t we need an anesthesiologist first? I felt for the flat space on the bone just below and slightly medial to the knee cap. Squeezing slightly, I started the motor. I inhaled as I felt the slight resistance of the tibia against the needle’s edge, then exhaling, I felt it give way. Ok, breathe. I had just started my first intra-osseous catheter! I decided that was possibly the scariest, coolest experience in my nursing education thus far!
Day three began where we had left off on day two, minus the drill. Simulated codes and various scenarios were run time and time again until our arms hurt from repeated compressions and our reactions to “code blue” were immediate. It was time to test. I was the first to be called for the check off. Taking a breath, I began to mentally rehearse my H’s and T’s and then I heard my instructor ask…
“What do you want to do?”
I knew, despite my pounding head, that H’s and T’s didn’t stand for” headache” and “tired” but somehow that’s all that came to mind. It all moved very quickly then. I heard my own voice saying, “We have V-tach, that’s a shockable rhythm, charge 200…can I get 1mg epinephrine and have 300 Amiodarone on hand in case we need it?” That fast, I passed my first simulated major code. I sighed with relief; my mannequin would live to arrest another day. Leaving the room on the last day of ACLS, I have more confidence than when I went in. In no way do I claim to be an expert; far from it. In fact when I witness my first actual code, I think I’ll probably still feel like I want to heave. I figure that’s normal. The confidence comes from having pursued something I was intimidated by and succeeding despite the fear. That has changed the way I look at things. I learned two very important lessons from ACLS. First, only defibrillate dead people. Second, I can’t possibly know what I’m capable of until I’m willing to risk disappointment. This course taught me the benefits of experience are worth more than the fear of failure. In the mail today was an envelope with my official certification inside. Staring at the little red card I smiled. Christmas came early this year.