Maintaining a patent airway in medical school

“GCS less than 8, intubate.”

“Right, what else?”

“Acute respiratory failure!”

“Good, and what are the contraindications?”

Crickets.

The small flock of medical students stares blankly into our surgery TA’s face, anticipating an answer, like chicks awaiting a feed from a mother hen. He pauses, then eventually tells us. We regurgitate the answers before dispersing to our stations.

My thoughts begin to race, as I quickly rehearse the intubation video in my head that I played at 2x speed the night before. Will I be given a Mac or a Miller blade? Which one is the straight one again?

I kill time by stating, “I would first …” and wave my hand over the Mayo stand like a magic wand. The resident looks on patiently. I determine that I have picked up a Miller blade in my hand (the wrong hand, of course), and then attempt to rely on memory for tips and tricks about the art of intubation. All I can come up with is, “Lift, don’t sweep. And try to avoid chipping any teeth.”

As the resident begins to guide me, I immediately clash against teeth. There went that goal. Crank. Clack. Click. The suction device rolls in slow motion to the floor with a clatter, and I wonder to myself if this is a form of modern-day medical slapstick? Minutes pass as I dig and yank around, exchanging the blade several times in my hands and squatting down, as if trying to reason with the epiglottis at eye level will somehow make it appear out of thin air. The resident feeds me more advice, but only in small parcels, and leaves space for me to reason why my technique is not working. I struggle, I feel vulnerable, but I am learning.

At last, I see vocal cords! I intubate the airway of the mannequin, see the chest rise, and give breaths via the bag. Procedural tasks have never come easily to me, so I visualize them before bed every night after I learn them to solidify how to use my hands when the opportunity arises. I find it hard to comprehend that I will one day perform this skill calmly, with precision, ease, dexterity, and a swift pace. Today, I reflect, I moved at a sloth’s pace, but at least my intentions were pure. As a beginner, that is all I can ask of myself.

Right now, a popular TikTok song is “The Good Part” by AJR, a band I’ve followed since 2014. I don’t necessarily expect everyone to relate to a TikTok craze but allow me to paint the picture for you. This audio purposefully uses a clip with the lyrics: “It’s so hard/Can we skip to the good part?”

I find it exceptionally effortless to want to “skip” through preclinical years “to the good part” of clinical years or beyond, and I often catch myself imagining my life as a resident or attending. Some professors, older physicians, or possibly even school administration members will bait you with this fantasy, of skipping to the good part to encourage you to keep slogging along. The reality is, “the good part” doesn’t have to be the pot of gold at the end of rainbow, the cap and gown at your med school graduation, or a celebratory luxury car purchase as an attending.

Listen to the full song, celebrate your mini-successes, and don’t get caught up with minutiae that make up the days that seemingly fly by, yet simultaneously drag on, in medical training. Tuck your medical slapstick experiences in your back pocket and pull them out on a rainy day. And when you learn a new skill, like intubation, allow yourself to feel invigorated by the dichotomy of nervousness and excitement and take it all in. Someday, that very skill may be used to save a patient’s life.

No need to skip to it; we are living the good part.