Mickey Vargus is curled up on the hospital bed, holding her sides as she shakes back and forth violently.
Her heart is pounding, she is having difficulty breathing, and shooting pains lance through the left side of her rib cage.
She clutches at her ribs, sucking in air through clenched teeth. Near the bed, she can hear two figures conversing.
“How’s things going next door?” asks Stephanie Sideras, buttoning up her white doctor’s coat as she peers over at Vargus hunched over in the bed, withdrawal tremors rippling through her body.
“We don’t know about the labs, but she’s really anxious and it looks like she’s been taking Dramamine and maybe some other things too,” says Jenell Bartell, a nurse.
“Okay, let’s see. She’s got the ribs, but other than that just really anxious right?” the doctor runs her hand through her silvery hair, frowning at the floor. “Okay, so just let me write something up, and we can get her started on some Chlordiazepoxide. When was her last drink?”
“She claims that she hasn’t been drinking since – probably yesterday.”
“How many hours?”
“At least 16,” says Cameron McGuire, another nurse. “Twenty hours I would say.”
“I’ll call it in to the pharmacy.”
“Okay Mickey,” says McGuire. “So we’re going to look into medication that will possibly make you not feel so anxious, and then we’ll keep you here and keep an eye on you.”
“We’re going to have a chest X-ray come in just to be sure,” adds Bartell. “And an EKG to make sure there’s nothing wrong with your heart–”
Sideras waves her arms, cutting her off.
“Okay team, we’re going to call that one right there, all right?”
A split second of silence. Then laughter and applause.
Mickey Vargus is not a patient suffering from alcohol withdrawal symptoms in the emergency room of the local hospital.
McGuire, Bartell, and Sideras are not emergency room staff.
They’re not in an emergency room.
In fact, they’re not even in a hospital.
They are in the basement of Southern Oregon University’s Britt Hall, in a nondescript meeting room with large windows looking out onto a dull, cloudy Tuesday morning, running a chronic standard-patient simulation.
In this 4-hour simulation, nursing students follow the course of Mickey Vargus’ life over a period of seven years, tracking her dependency and eventual abuse of alcohol. Mickey is an amalgamation of different patients, whose personality is designed to reflect that of a “standard patient” suffering from alcoholism.
These simulations are part of the backbone of the Oregon Health and Science University’s School of Nursing, one of the premiere nursing programs in the state of Oregon, and help to reinforce the skills student nurses learn during their nursing practicums.
“We know that nothing replaces work with live clients,” said Sideras, OHSU instructor, simulation coordinator, and occasional stand-in doctor. “[But] the problem with clinical practice is that a lot of the student time is wasted … you can’t guarantee that a student is going to run into a Mickey at their placement.”
Sideras explained that the simulations are used to supplement the program’s clinical placements or internships and “level the playing field” among students in the class, some of whom might have different experiences during their clinical practice.
All nursing students are given a clinical placement, Sideras explained, but simulation work allows her to use her student’s time most effectively, covering in four hours what a student might not even see for an entire month at their placement.
“It’s ridiculously stressful, but it helps,” said Heather Headley, a nursing student who participated in the Mickey Vargus simulation. “It really gives us the opportunity to screw up and not kill anybody.”
There are two kinds of simulations that are run by the nursing program – acute and chronic.
Acute simulations use sophisticated remote-controlled mannequins to simulate medical situations where students must act quickly and decisively to save the imaginary patient’s life.
Chronic simulations use live actors, typically volunteers from SOU’s theater department, and focus more on chronic health conditions and long-term patient care.
Chronic simulations are often more nuanced than acute simulations, as the focus is more on talking to the patient and getting accurate information.
The Mickey Vargus simulation is one of several different chronic simulations run during the course of the program. Although typically a theater student plays the role of Mickey Vargus, during this particular simulation Sideras and Glenise McKenzie, an assistant professor at OHSU, shared the role of Mickey.
Mickey Vargus isn’t the only simulation the nursing program runs. There are several binders stacked up against the wall in Sideras’ office, each with a name in bold-face type – Ryan Reynolds, Thomas Challenger, Jessie Sue LeRoy, Ron Knight, Martha Gorski, and Alice Nyman.
Each binder contains a wealth of information about an entirely fictional character, from their personal medical records to how many dogs they have. Each character has been meticulously developed over the years, carefully fine-tuned and adjusted to meet the needs of each nursing class.
“We started [the Mickey Vargus simulation] off of a simulation from Portland where he was in the last stages of his life due to alcoholism,” said Sideras. “We wanted to give them an earlier introduction to substance abuse, so we moved him back in time.”
Not all simulations deal with substance abuse however. The Ryan Reynolds simulation pits students against a young, twenty-something college student exhibiting signs of schizophrenia.
“[Ryan Reynolds] was developed by Donna Markle, one of our best psychiatry nurse practitioners,” she said. “It’s designed to showcase the effect of schizophrenia on the family.”
Actors meet with faculty members several weeks before the simulations begin and discuss the goals of the simulation, and what faculty wants the nursing students to learn during the process. Typically about two weeks before the simulations, the actors meet with the faculty again to discuss how their character thinks, acts, and talks.
During the actual simulation, the actor has a microphone in their ear, through which faculty can tell them to turn up the pressure to keep the students on their toes, or dial it down if things are getting too stressful.
“We’ve got great access to theater students who’ve been very willing to work with us,” said Sideras. “The reason they like to do simulations is because it’s so improvisational.”
Sideras explained their actors are incredibly talented, and have even brought students to the point of tears.
“It can be pretty scary,” she said.
“What makes simulation work is making the student believe that what they’re experiencing is real,” she said. “We work hard to help them see the reality of the situation.”
Back in the makeshift emergency room, chairs are moved, and everybody sits down around the table for a quick debrief. What were some of the things they missed? How would they act if presented with a similar situation again? What did they learn?
After a quick wrap-up the students get up and leave, taking their coffee cups, their empty water bottles, and their mini frosted muffins with them.
They’ve been in this room for the last four hours, and some of them will be coming back to this very same room for a class later on in the day. But for now, they’re happy to leave.
Someone wonders if they have time for lunch before their next class. Sideras tidies up and closes the door, turning off the light as she leaves.