I stood at the head of the stretcher, facing down toward the foot, with a female patient lying before me, an endotracheal tube in one hand and a laryngoscope in the other. She had been in a terrible car accident, and now, she was covered in blood, her pants were soaked with piss, and she was regurgitating blood. If I didn't get this tube in, she would likely drown in it.
The room was noisy – shouting, crying, alarm – and crawling with nurses, all of whom were rushing to save the patient and her children, an infant and a four-year-old, who were in only slightly better condition. I wished one of them was my patient instead of the doomed lady in front of me. It was clear she was going to die, but it was my job to provide a clear airway, not to decide at which point we had provided "adequate care."
I looked down at her, her head tilted back and ready for me. "I can do this," I said to the nurses watching me, lying as I announced myself as the "respiratory therapist." They knew it was a lie too, but they didn't call my bluff. They recognised I was here to do a job that they either couldn't or wouldn't do, and so they stood back as I used the blade of the laryngoscope to push her tongue down until I could see her vocal cords and slide the tube into place. One of my teammates rushed to the side of the four-year-old's bed. The child had stopped responding, and she was doing everything she could to get him back. I knew how, but that wasn't my role in this – my role was to get a bag attached to the end of this tube so my patient could breathe. I pulled the metal guide wire from inside my tube and attached the bag, squeezing. Her chest rose.
My heart was pounding. How did I get here? I asked myself for the third or fourth time. I was an IT guy, not a medical professional, and these people all knew it. I moved over to help my teammate with the four-year-old. And then…
"Simulation over," announced a voice through a loudspeaker overhead. Everything stopped – the alarms, the three patients crying – and the room let out a collective sigh of relief. "Clean yourselves up and head to the debriefing room."
One by one, the nurses filed out of the room while my teammates and I turned to cleaning and resetting the room to do it all over again. Luckily for me, the next group would have a few ER nurses and at least one doc, so I wouldn't have to act for another hour or so.
I work in a fake hospital. We have six ICU rooms, a 20-bed medical bay, and an 18-room outpatient facility. I'm a medical simulation technician, which means I help nursing and medical students learn how to perform medical procedures on our mannequins. Technically, they're "human simulators," which, in addition to serving as lukewarm bodies in the hospital beds, can blink, breathe, pee, cry, and bleed. They have fake pulses, heartbeats, lungs, and bowel sounds. We have 26 of those, including a newborn baby, a five-year-old kid, and a mom who can give birth (click that link at your own risk). On a given day, I'll do anything from aiming our security system–like cameras and editing video to doing stage makeup and mixing up fake bodily fluids. In addition to those jobs, I also program and maintain the mannequins. Oh, and I clean. A lot.
I am not a medical professional. My background is in IT, and most of my skills before working here were learned downloading illegal movies and watching porn on stolen WiFi – and then cleaning up all the shit that tagged along with said movies and porn. That is to say, I had no formal training: just a childhood with the internet and a couple programming classes in high school.
Yet, in the scene described above, I was expected to not only play the part of the respiratory therapist, but to program the vital-sign changes in all three of the patients. It was also part of my job to mix up about two cups of fake shit and splash some fake urine over the patients' pants. Once the simulation ended, I had to stop the recording, pull the video up in the debriefing room, clean up whatever fluids were smeared around by the previous batch of nurses, and set up my equipment to record the next round.
All in all, it's one hell of a job.
I've seen students climb on top of my patients to preform CPR as though they're in a scene from Grey's Anatomy. I've seen a teacher knee a student directly in the face (the teacher was acting as a combative patient, and the student's job was to get him back in bed and restrained; the student leaned down just as the teacher's knee came up). I've had campus security called on the scenario because we forgot to send out an email to the college warning them that we were going to have an altercation in the lobby involving a clear-plastic airsoft gun that was going to end in a heart-attack scenario. And I've seen students quit the program in the middle of a scenario because they couldn't handle the stress of an combat veteran going through withdrawal from alcohol – played by an actor – heading down a path that ultimately would have ended in the patient committing suicide.
These aren't just scenarios we make up to confuse students. Most of them are actual cases that our faculty members have experienced in their own practices (without any identifying information, of course). These cases are structured in a way that can show the students what they may experience in the field, and teach them how to act if they do – the same way the airline industry has been doing it since 1910, focusing on standardisation and repetition.
At the end of the day, what we do in this fake hospital has been proven to improve patient outcomes in the real ones. That's what keeps us coming in when our backs are sore from lifting 80-pound mannequins off the floor, when our scrubs smell like Liquid Ass spray (a real product, which is exactly what it sounds like), and when we're all sick of the pressure coming from above to pull Hollywood-level production value from a high school musical budget.
Back in the hospital, the nurses were leaving the simulation room and my team and I had jumped into motion, resetting everything for the next group. The room was an utter disaster: One mannequin's shirt had been cut off, revealing a large seatbelt bruise across her chest that had been smeared beyond usability. The newborn's diaper had been removed and thrown away; on the far side of the room, the child's gaping head wound had been bandaged, and the stacks of gauze used to clean the wound had been dropped on the floor and kicked around, leaving bloody streak marks across the floor. All of that had to go – everything had to return to zero to ensure the same experience for the next group.
As usual, I started with cleaning, scrubbing the remains of my mannequin's bruising. Sometimes, I can save it, but not this time. Across the room, one of my teammates was wiping blood off the floor with a wash cloth and a spray bottle of Simple Green. Our other teammate had the easiest job: He already had a new diaper positioned under the fake baby's ass, unfastened, with a small syringe of fake urine next to it for the last-minute addition, and had turned to troubleshooting the kid's connection. For some reason, the mannequin had stopped communicating with its computer, rendering it, for all intents and purposes, dead.
When everything was clean, we turned to makeup and fluids. I sprinkled some baby powder on my mannequin's chest and rubbed it in to give the makeup good footing (unsurprisingly, silicone skin doesn't hold makeup very well) before pulling out my sponges and palette of bruise-coloured stage makeups. I painted on reds, blues, and purples, spreading the bruise from her left shoulder to the lower-right of her rib cage.
The group of nurses had finished debriefing, and they walked past the simulation room as they left the centre, reminding us to pull the curtains shut to hide the scene from the next group. We try to stay behind the scenes, to keep things feeling as authentic as possible, but the curtain tends to get forgotten when we have a lot to reset.
My coworkers continued to work on the kid. One was stippling on gel-blood to indicate road rash; the other was getting the kid reconnected to the computer, verifying connectivity by making it say one of its 15 pre-recorded responses, like, "There's blood in my poop!" I returned to our control room. The cameras in the ceiling were all aimed at their respective beds, only requiring a little tweaking to get back to their starting positions, and I punched the next group's team name and the date into our video recording software then selected "Restart Scenario" in the control software for my own mannequin, leaving them both one click away from starting.
The next group was already arriving, so I raced back to the simulation room to splash some fresh piss on my mannequin's pants, give her a quick spritz of Liquid Ass (remembering, at almost the last minute, to glove up so the smell wouldn't stick with me all day), and squirt the syringe of pee into the baby's diaper. As I was fastening up the diaper, I heard the facilitator in the hallway start briefing the next group:
"You've been called to the ER for a witnessed rollover accident. There are three patients – the mom and baby were wearing their seatbelts, while the five-year-old was thrown from the vehicle – and all are in critical condition. You arrive just as EMS is leaving, already called out on another call…"
People often ask how we pull it off, how we manage to artificially create the sense of life-or-death chaos that comes from a medical emergency. I think it comes down to the authenticity of the bodily fluids: For fake poo, I mix chocolate pudding, applesauce, canned corn, and peanuts. Then I spray the mix with a couple squirts of Liquid Ass spray, stir it up, and spoon it over any of those fake dog turds you can get at any novelty store. For fake vomit, I mix lemon juice and parmesan cheese together for smell, then I add corn starch for consistency. It smells horrible, but it would probably taste great if you put it on chicken.
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