We were still at the top of a mountain when one of my students fell. We had decided to explore Harney Peak on our day off from a service trip in Oglala, SD, where we had no cell phone service and the nearest hospital was over an hour drive away. As one of two leaders on this trip, I opted to hang at the back of the group, where a couple girls were struggling to keep up. Ashely had fallen three times already, and as a physical therapy student all I could think about was that she would be lucky to make it down in one piece with her weak hip abductors and poor balance. The fourth time she fell, she immediately cried out that she had hurt her leg. Honestly, I am not entirely sure what I did then, but no more than two minutes later, Ashely was sitting on a stump, her ankle expertly wrapped in an Ace bandage, two Tylenol in one hand, and a bag of snow serving as a homemade ice pack in her other.
This was the first time I had ever been involved in a crisis. I had little experience with acute injuries and was always afraid that when the time came, I would panic. Even after the experience of half carrying and half dragging Ashely down the mountain, that fear still exists. Luckily for Ashley, her emergency was only four torn ankle ligaments, and while that state of injury should not be belittled, it did not threaten her life. I know that as a future medical professional, I will at one point stumble into a potentially fatal medical emergency, and I will need to rely on my expertise to do whatever it is that needs to be done.
Because I have never practiced my knowledge of basic life support, I would be falsely advertising if I claimed to know the secret to a successful resuscitation. However, what I find most useful in high pressure situations—practical exams, job interviews, even piano recitals—is to tell myself three things. The first is not to panic. This seems obvious, but freezing or overreacting is so much easier than keeping a level head. Nothing good will happen if I chicken out; in the case of a medical emergency, I may cause the patient to panic, and that is not helpful. The second is that I know what to do and how to do it. Just that little boost in self-confidence is often enough to get a situation under control. The third is that I am in charge of the situation, no matter how out of hand it may feel. Knowing something and doing something are two different principles, especially should one find himself at the top of a mountain in the middle of nowhere without cell phone service with a student who can no longer walk.
When I know I am about to enter high pressure circumstances, I often pretend to be a professional. It sounds ridiculous, but it works. Before every practical exam, I tell myself over and over again that I am a Doctorate of Physical Therapy, even though that is not yet true, because (theoretically) someone with a doctorate must know what they are doing; ergo, I must know what I am doing. While practicing for such exams, I often find myself floundering, using clumsy language and forgetting important details; however, once in the exam, if I believe that I am actually a trained and licensed DPT, I can wield a goniometer as if it were simply an extension of my arm. We, as typical members of society, habitually trust authority figures, including medical professionals, without hesitation. If I can harness that trust in authority and turn it into self-confidence, then I will be able to handle any stressful situation.
At the top of that mountain, I was the only student with any medical training whatsoever. It did not matter that I knew next to nothing about ankle sprains; all that mattered was that I acted like a professional so that Ashley (and everyone else) would keep calm so we could get her home safely. Looking back, I have since learned exactly which ligaments Ashley would have torn, how to read her MRI, and which electrophysiological agents would be most appropriate for her treatment, but knowing all that would not actually change what I was able to do for her there. Over the next few days, my other group members joked that I was a “first aid ninja”; to me, I still felt like I had no idea what I was doing. But that’s exactly what so much of entry-level healthcare is—an act. We do our best to pretend that we know what we are doing until, one day, we find that somewhere along the way our façade of knowledge and confidence has morphed into authentic self-certainty.