Getting the Blue Card

The only blue card left on the table was labeled “R3.”

Today would be the day I would be the third-year resident, coordinating and leading a team of nine health care providers, during our patient simulator session at the San Francisco General Hospital Simulation Center.

I knew I was running late today. Four hours of lecture and small group this morning was enough to give me an appetite. So, a quick trip to Subway was in order for a foot-long veggie sandwich (I never seem to get any satiety from the six inch subs). But the line was not quick and the bus ride on the blue shuttle took longer than expected, making me arrive at the General just in time to get the last unwanted assignment.


All my other classmates had arrived earlier and snagged the RN, fourth year medical student, third year medical student, Respiratory Therapist and intern positions. I was left with third year resident position.

I have no idea why anybody would not want be an R3. You simply watch over everyone and assign tasks. The only caveat is that everyone turns to you for guidance and answers. And you have to report back to the higher powers.

Our patient was Mr. Webster. He was complaining of dyspnea (shortness of breath) and chest pain on inspiration. The differential diagnosis for his chief complaint is akin to opening Pandora’s Box of pulmonary and cardiac diseases. I'll be spending my weekend studying this material for our upcoming Pulmonary Exam.

On appearance, you’d know right away that something was clearly wrong; Mr. Webster was not just breathing hard, he was made of plastic and had a mechanical motor for a heart. But as our real fourth year medical student leader put it, “he is more than a dummy.”

In fact, he is a patient simulator that allows teams of health care providers, everyone from first year medical students to physicians to nurses, practice and work together during simulated patient cases. Mr. Webster can become tachycardic, hypotensive, ischemic, and hypoxic—with the push of a few buttons. And he can talk, moan and tell us his story. We just have to ask all the right questions.

As health care providers we work so hard to prevent any types of events that endanger the lives of our patients. The last think you want to hear is CODE BLUE, while your patient slips away. But when we do find our patient in distress, we need to know how to act and simulating such cases makes us better equipped to serve our real patients.

And being an R3 really is not that bad.