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Capstone case study arthur andersen order capstone park fishing rules for money report traffic qldt2 so what's my other unique qualification well it's this I wasn't cut out for this at all I'm an inherently anxious person I have a fragile psyche and I'm overly empathetic I saw someone give a course on self-defense once and they say whenever you're watching a movie and there's a fight scene regardless of whether it's the good guy or the bad guy that's dominating in the fight scene you should always try to identify with the person that's given the beating and not the person that's receiving the beating I'm not that guy I become overly empathetic I even when I was in middle school I remember some kid got sick at school and puked it freaked me out so that I empathize with it so bad I became incredibly fearful of becoming sick and vomiting to the point that I made myself sick anytime that I thought about it it was insane my first er experience when I was in college I thought I want to go to medical school this is what I want to do and part of that was you had to demonstrate some curiosity about the medical field so I volunteered at University of Texas Health Science Center emergency department and my very first experience as a volunteer I was useless so they did what they could do with the useless volunteer we had this little Vietnamese guy spoke no English who was schizophrenic who was being held to be admitted to the psychiatry unit but he's being held in the ER and he needed a sitter so they sat me down in a chair and this little Vietnamese guy sitting there and talking to himself and he smiled at me and I smiled at him and he opened his mouth stuck his tongue out and he had a single edge razor and I froze he just took it out I thought oh my god he's gonna kill me and then he took this single edge razor and he shoved it in full depth into his wrist and then he went vertically with a full depth of the razor up like this and I remember feeling the sensation of ants crawling on my forehead and my vision was like I was looking through a paper towel roll and then there was nothing and when I came to there was this huge ruckus of people stepping over me as they were wrestling with this guy and trying to get in control and they sent me home it was the most humiliating experience and it clearly yeah and I mean it was even said to me you were not cut out for this don't even think about it medical school is a similar experience it was the most miserable four years of my life I got into medical school by being the ultimate anal retentive studier I studied from dusk till dawn I always made sure that I was going to get an a on every test so I could get into Medical School which I did but once I got into the medical school and the volume of the material was so great I didn't know how to scale back and quantitate my effort so the way I compensated for that was I woke up at 5 in the morning I studied until 1:00 in the morning for two solid years because the only way I knew how to do it I did not know how to calibrate getting a B or getting a C or any of that when I got to my clinical years the I knew I would be seeing sick people I had no conception of how sick people could actually be and how overwhelming that was and you had this sense of you had to manage or fix something that was completely unmanageable so it I would vomit frequently every morning before going in for rounds if not in vomit diarrhea at night when I would finally get to sleep and these were on rotations where you have every other night call so you're awake for 36 hours you get to sleep for 6 or 7 hours and then you wake and do 36 hours again over and over but when I would sleep I would have night sweats and soak the bedsheets that's how terrified I was through the whole process so I clearly was not cut out for this but I wanted to not feel fearful anymore so why did I choose emergency medicine if all this is true well I was tired of being scared I didn't want to be afraid of anything I was tired of that feeling of not knowing what to do or not being able to deal and I wanted to be in control of the chaos or I at least wanted to contribute to the chaos in a way that put me as part of the process rather than someone being acted upon and I didn't want to be afraid of anything in any specialty so how'd I do this well in a word stress inoculation I've sucked it up I faced my worst fears by provoking them and I lived through it when I was in middle school I told you about the whole fear of throwing up kind of thing I finally got to where I was just sick of this I was just so fearful I was gonna catch a bug and start vomiting and that it would be so traumatic I had a really big meal I drank a lot of milk I went out to the track and I ran as fast as I could as long as I could until I puked and then I got over it literally in that moment got over it sometimes you just got to find an alternative and then fake it you got to act like the guy that you want to be and just fake it until you make it and then the lastly is get some skills read books find role models look seek out a mentor get educated and study like he'll get mastery of something so that you can be confident in a situation and in the medical aspect emergency medicine was facing my worst fear throughout medical school I did see circumstances where different specialists specialists when they were actually encountered with a center of the pie scenarios that we had talked about earlier literally came unglued I could see it happen and I did not ever want to be that and I didn't want to be that under any circumstance in medicine and that's why I chose the specialty that I did you another and that brings us to dr. Doug macguff let's bring it home first time I remember having it we were at the end of shift and I was coming on and we were talking about the patient's the ambulance rolled between us with this well-dressed middle-class looking guy curled up on the stretcher moaning and groaning and acting dramatic and I thought now brother that guy rolled between this and my attending said keep a close eye on that guy he's got mesenteric ischemia meaning one of the arteries to his bowels is blocked and he's dying I'm like how'd he do that well two and a half hours later after multiple testing and an angiogram of the gut he was right okay and I realized because this guy was well dressed and he was acting dramatic I made an assumption about him and I latched onto that for normalcy bias I see it with nurses they'll bring back a patient that and if you ever show up in an ER kind of look a little scrunchy my friends don't wear your clean underwear because the more normal you look the more normalcy bias will kick in for the people taking care of you we can believe that some derelict that we pulled out of the gutter is going down the drain but you come in you know with your you know khakis on and a nice pressed shirt and you're doubled over it's kind of like a whatever because your brain seeks normalcy I see them bring someone that's actively dying and put them in a non acute room and if you're seeing a really sick patient in a room that's designated for not sick people your brain will run to normalcy bias and you have to protect against that and then finally we want to be able to bend the curve and what we're looking at here on this curve is you have performance on the y-axis and heart rate on the x-axis and what you'll see is as heart rate goes up you reach this optimal performance tone here at the top okay if you get too stressed out you start to go in to that realm where everything starts to go to pot well there is a way of performing stress inoculation to bend that curve so you go from condition red instead of going into condition black you just extend condition red out further through the loops and think in terms of breathing self-talk actually do all those things capstone project examples pdf government online Swedish Institute of Massage Therapy.