We finally broke down and bought floaties. The kids had played for a few days in the shallow water. Neither of them were proficient swimmers and they dared not venture into deeper water. But each day they longingly watched kids younger than they were scoot around the pool wearing the cartoon-decorated, wing-like contraptions.
I never liked the idea of floaties. I thought it was much better to let the kids try and advance on their own from last summer’s lessons.
But as the days passed, we realized that with a little more independence they would have more fun.
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Of course, they were overjoyed when we fit the balloon-like apparatus over their arms. Their physical limitations disappeared — but so, too, did any need to grow and learn.
Now switch to another scene. It was midnight, and the usual hustle and bustle of the VA was oddly quiet. The oversized spinal needle gleamed as I held it up before attaching the 50 cc syringe. I had worked my way through the pulseless electrical activity algorithm and finally had come to pericardial tamponade.
A little over a year before, I had been a medical student. Now I was the most senior physician in house. I was about to plunge a large needle below the xiphoid process and angle it up toward the heart. Then I would pull back and advance slowly.
Blood squirted into the syringe like a red tsunami. I looked up at the monitor and noticed the rhythm had converted to sinus. Moments later, I palpated a pulse when groping for the carotid artery.
My patient would code a few more times that night before eventually succumbing. Each time, the interns and I would race to the bedside and commence resuscitative efforts. There were no attendings, no senior residents — no floaties.
Now, a decade later, medical training has changed. The transition from learner to decision-maker is more gradual. By the third year of training, many residents have never run a code by themselves.
The problem with flotation devices is that they allow you to think you can swim when you really don’t know how. They do not help you develop the skills you will need to keep your head above water. They are a crutch — life-saving at first, but deadly in the long run.
We need to reconsider how we train our doctors to be sure that they acquire the skills they will need. Careful oversight has to be balanced with incremental decision-making and independence.
At some point or another, the floaties have to come off.
Will the doctors of tomorrow know how to swim when they really need to?
