Setting the tone

• When things go pear-shaped in a hurry and there needs to be a rapid change of plan, the doctor in charge is largely responsible for creating the atmosphere in the room. I’ve witnessed this a number of times when there are signs that the fetus is in distress (decreased heartbeat) while a woman is in labour. Or during a delivery if the baby gets stuck part way out and needs to have either an operative vaginal delivery (that’s what it’s called when they use forceps or a little vacuum suction cup on the baby’s head to pull the little one out) or some other intervention. This is when it is a bit scary to have both the patient and the patient’s partner/parents in the room and witnessing the flurry of activity as new people enter the room (that they’ve never seen before), and the paediatrician arrives and starts setting up the warmer & gear to resuscitate the baby.
• Different doctors react differently. One doctor I was with suddenly raised her voice during a vaginal delivery and said “Get Dr. X (the obstetrician) NOW!” in the midst of other rapid-fire instructions. I went out and got the doctor she was looking for and everything turned out fine, but it was far from a relaxing or reassuring moment for the patient. Another doctor, actually an obstetrician, has an aura of calm that surrounds him when he walks in the room. No matter what’s happening he introduces himself and speaks in a low tone & volume. It’s amazing the difference it makes. We all follow the instructions of whatever that needs to happen but it’s so much less stressful for everyone, particularly the patient & her family. What a difference it makes. I’ve heard the same thing from my colleagues about some of the docs working in the ER – the manner in which they approach an emergent situation either raises anxiety or decreases it significantly, even if they do the exact same thing. Not sure what my reaction will be when I get to that level of training. Right now it’s pretty nerve-wracking to not know exactly what to do to help unless I’m told. I guess I’ll find out when I start getting involved in responding to “code blue” (cardiac arrest) calls in the hospital as a resident. Ugh.