Lakshmi Rodriguez is laid out in a hospital bed, blinking up at the ceiling, her long black hair tousled on the pillow.
She's in pain due to a recent hip replacement and will require more medication. But there's a risk: Caregivers could give her too much medication, or fail to consider the possible negative interactions with other drugs she's taking.
Those risks are elevated because Rodriguez speaks broken English, and the two people charged with unraveling this puzzle are still nursing students.
The students bend over the bed to ask what drugs their patient has already taken. Rodriguez is confused.
"I no know," she moans.
Thankfully, Rodriguez won't be harmed should the students make a mistake. She's a robot.
While real cadavers are the best tool to learn anatomy and physiology, nursing students benefit from something that's one step off from the real thing — human simulators. The Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences at the University of Colorado at Colorado Springs procured its first human simulators in 2012.
The school now has seven — four adults, two children and a baby — ranging in price from $25,000 to $100,000.
Tim Russom, the school's simulation technician, says the simulators provide an experience that's incredibly similar to treating an actual patient.
"They do everything," he says. "They're physiologically and anatomically correct. They can poop. They pee. They cry. They bleed. They sweat."
Pointing to one simulator, who is usually called "George," he says, "This guy can foam at the mouth. He can have a runny nose. Stuff can come out of his ears. Their eyes blink. Their pupils dilate. His chest rises and falls. He has nine pulse points, [and] full heart, lung and bowel sounds."
The simulators look somewhat similar to the mannequins you see in store windows. But they can easily catch you off guard when they blink, speak or make some other sound.
"They make some throw-up sounds that are so realistic that you want to jump away," Teresa McKay, a clinical faculty member and a practicing registered nurse at Memorial Hospital, says with a laugh.
Since the simulators are so close to the real thing, every hour caring for them counts as a "clinical hour." In fact, the approximately 450 students in the nursing program get 20 percent of their clinical hours on simulators, with the rest taking place in hospitals.
The simulators allow students to try out tricky scenarios — from working with someone who can't speak much English, to performing a tracheotomy. All the simulators can be used as either male or female, with the exception of "Noelle," who gives birth.
"She can deliver babies in any way you can imagine and in a lot of ways you don't want to imagine," Russom says. "According to the last time I looked at her, she's had almost 5,000 babies. She's a very busy lady."
There are several ways that students learn from simulations. Often, they start in a 10-bed lab and practice various procedures, often on static mannequins that have less functionality. There are also human actors who come in to present students with social problems that they're likely to encounter in a hospital — a new mother who's scared of the baby's father, for instance. Russom and other staff actually shadow students in hospitals to come up with the most realistic scenarios, and even transform rooms in Beth El into apartment-like settings to mirror a home visit.
But the most fascinating simulations use the life-like simulators. Three rooms at the school are set up just like a hospital room. Students wear gloves and scrubs when treating their patient. Behind one-way glass, a teacher and others watch the students work their way through the scenario, while keeping an eye on monitors that show vitals, like the patient's heart rate or blood oxygen level. One person actually plays the patient's voice — whatever he or she says into a microphone comes out of the patient's mouth. Students can treat their patient and make calls to the "doctor" (i.e., their instructor).
Take George. Today, George has a collapsed lung, and his symptoms are getting worse. Air from the hole in his lung has escaped into his body. His student caregivers need to pump that air out of his chest with the help of a doctor. In the meantime, George is really suffering.
"Do you know where you are?" one of the students asks him.
"Yeah, I'm still in the hospital," George pants back.
George moans through the procedure, which the students handle quite well. When it's done, George complains that "it's still kind of hard to breathe." The student assures him that it will soon get easier.
"End scenario," George snaps, breaking out of character. "Thanks for saving me."
Rodriguez doesn't fare quite as well today. The students do their best to communicate with her. But Simulation Technician Uma Chinta, who speaks an Indian dialect, is playing the voice and she purposefully makes it a little difficult for them. The students catch most of the problems with Rodriguez's medication. But the patient ends up taking a bit too much Tylenol. The students get a chance to meet with their teacher after the simulation ends to talk about what they can do differently in the future.
"Once people have too much Tylenol, we've got to change over to another med or split up with the Tylenol," McKay, who is instructing today, explains. "This one [was] also about the Coumadin and high lab rates, so they really [had] to focus on the finer points."
This time, though, it's no biggie — just a learning experience. That's quite a change from the way it used to be. Before simulators were created students learned mostly on real people, and often practiced procedures on each other. Lynn Phillips, the simulation learning center director, says that's how she learned — and it could be quite brutal, especially when using large needles.
Thus the simulators offer a better route.
"The way medical is — and this is medical in general not just nursing — is you learned in the hospital on real people and a lot of times people would get real nervous about a student learning on them," Russom says.
"So what's happened is with simulation, we're able to put our students in situations like with the collapsed lung, and they can actually experience what that's like before they experience it on a real person. And the way we help our students with this is we want them to make their mistakes here in the sim lab, so when they deal with it on a real person they won't make those same mistakes."