Brandon L. Farler Submitted 2020-09-09

If you are reading this, you want to help people. That basic human desire placed in countless people around the world drives us to educate and train ourselves in various capacities. I have been a nurse for approximately five years, and I spent three of those years in intensive care units and emergency services. I have performed CPR countless times and have been truly privileged to witness wonderful and tragic outcomes. Now in the final stages of obtaining my terminal degree as a nurse anesthetist, I constantly see other healthcare students starting their first exciting days in the clinical setting. It is my earnest desire that these words will help you mentally and physically prepare to save someone’s life.

You should never allow the adrenaline of a situation to dictate your response to the situation. So how do healthcare providers get past that initial rush of catecholamines, their pounding hearts, sweating brows, and shaking hands? The answer is seen all over the curriculum: Repetition in decision making breeds automation in response. Comprehensive algorithmic thinking provides the best output to a given set of variables. No situation where you will be implementing these techniques is ideal. You may be in your community performing them with little to no information about the victim. In those times, when the human psyche wants to shut down from stress and pressure, it’s imperative to rely on the training. Use the algorithms you’ve been given because they will be a constant source of confidence as the most up-to-date care the patient can receive. Trust what you’ve been taught and implement it without hesitation.

When I was eighteen at the beginning of my career, a wonderful MD looked at me and said with a calm, sensitive tone: “Brandon, you need to remember…you can’t save them all.” She wasn’t cold, and she was not lighthearted. But there was some subtlety in her tone I knew I heard but wasn’t understanding. She was helping the future version of me. She knew what I was walking into before I did, so now I wish to help you with those same words. Here is how I came to understand them. Knowing your ACLS, BLS, and PALS certifications backward and forwards, practicing them, and keeping your edge is extremely important. It’s important because when the situation turns ugly, you will know beyond all doubt that you did your best and sometimes you just can’t save them. Strong didactic understanding and algorithmic thinking will help keep the adrenaline from overwhelming the scenario you have practiced 100 times. When those tragic times arrive in your career and everything you performed couldn’t have been enough, you will then be admitted into the highly privileged, small group of people to truly understand the esoteric tone of my wonderful MD. Luckily, the narrative doesn’t end there.

You must celebrate the victories! It comes in various forms. If you are given the honor to successfully implement CPR, there are few things more rewarding than tirelessly working as a part of an effective team for fifteen minutes that ultimately save a life. And there you have it. The two strongest victories you will have. The trusting family-like relationships formed during those trying moments and the high victory that is measured by heartbeats and QRS complexes. The words “I have a pulse” will take on new meaning for you, far past anything heard on Grey’s Anatomy. I guarantee the hours of drilling and memorization that lead to comprehensive algorithmic thinking complemented by strong foundational knowledge, will be worth it.

Finally, find ways to pour into others the same information you have been taught. When you teach others something you have learned, typically you’ll come to understand it more deeply. Counterintuitively, the teacher often gains more than the students. Teach and humbly learn from each other. When somebody corrects your hand placement, don’t scoff - be thankful. Likewise, when you are advising someone that their compression rate is too slow, follow it up with an offer to assist. Non-constructive criticism in the classroom or the field will ultimately harm patients. Yet positive, warranted, constructive criticism will benefit the teacher, the learner, and the patient. If you have a passion for the science of resuscitation, highly consider going on to be a CPR instructor or code leader.

A lot of the times in life we know something mentally. It’s more a theory than an experienced reality. All these things above may feel that way right now. One may believe that the heaviness of these words is simply stylistic. But if you continue long enough, you’ll discover that these words were not written from some high ivory tower but that they are heavy because they came from a weighty reality that you have not yet found. So, when you find it, I hope that you are prepared with comprehensive algorithmic thinking strengthened by foundational knowledge, surrounded by an effective team that learns together as you strive for every exhilarating heartbeat victory.