Sunday, August 1, 2010

Failed Resus

So glad he called it early.

It was an unwitnessed arrest of grandpa, the 8 year old called 911 because mom was out on a run.

Seeing people quietly in shock is more disturbing than watching people grieve loudly and dramatically.

It wasn't a messy code, like they usually are. It was just very apparent from the start that our efforts were in vain. We tried but, as the name implies, asystole is a hard rhythm to come out of.

We had a medical student start with us today, I went in the resus room after we'd all cleared out and found him in there with the patients daughter, a hand on her shoulder. I was impressed. We worked most of the day together but I didn't tell him that I was a medical student as well. He's actually a legit student, where as I am kind of more like a hospital crashing renegade medical student.

On the other side of the equation I did get to witness a birth yesterday, and I was happy to feel tears in my eyes when the baby finally emerged. I like getting an unexpected jab of emotion at work, it makes me feel less like an ED-Bot who works unflappably at putting out tiny fires all day but gets no major satisfaction out of a lot of it.  The doc I was with said I can catch the next one. I have since been creeping the maternity admissions.

And now...I need to cook dinner and let my shoulders relax.

8 comments:

K said...

Cool (the second part). Sad (the first part).

medrninja said...

Great post ABB. A Day In the Life, I think you summed it up beautifully.

As for being the hospital crashing renegade medical student, I know what you mean. I feel like that every day...

Old MD Girl said...

I had a hard time figuring out what your title meant. I was like, "How does a Rhesus monkey have anything to do with a code?"

God I'm dense sometimes.

Albinoblackbear said...

K--Yep. That pretty much encompasses the emotions that I oscillate between in health care.

Ninja--Thank you, it felt sparse but that is also kind of how I felt when I wrote it. :) Heheh, here's to renegade non-trad meds!

OMDG--Love that you admitted that! hahahah

Cartoon Characters said...

I worked at St Pauls for 5 yrs...do you ever get there? :)

Albinoblackbear said...

Yesssss...many 'o' time. Transfers from Whistler and MMH, mostly to the ED but sometimes to Cardiology as well.

My old roommate (Tracy J) and pal from Whistler worked in St. P as a nurse for ages in the ED--she's in Kandahar now with the military. Actually, I know a few peeps that are still there, some that have moved on. Couple of the docs too...Eric V, Annie G. Not sure where they are now.

Keet said...

That is beautiful. Healthcare really does provide you with an interesting if not always pleasant life. I had a successful resus the other day, and I work in a very non-acute setting.

Picture it, Hackney, (the fourth most deprived borough in England) East London, 2010... a man who's consumed 7 cans of strong lager and 40 quid worth of crack wanders into a specialist addictions unit to have his 3 week old compression bandage changed because the smell of his pseudomonas colonized venous leg ulcer is bothering his girlfriend, (who he pays for, btw). As we chit chat as nicely as I can while trying not to vomit all over everything, and he washes his leg and tells me about his day and what he's had, I wonder what I'll do this evening. We begin the laborious process of wrapping up his yucky leg in layers of bandage, when suddenly he slumps on the exam table. I shout at him to stop playing around and keep wrapping, but when I look up he's unconcious and not breathing. I drop the leg, and check for peripheral pulses, weak and VERY irregular. Still no breathes. Pupils are equal, dilated and unreactive to light. I call for help and one of the addiction workers rings for the code team and then stands by helplessly while I bag him until the code team arrives, his heart beat skipping randomly along. A very long 3 minutes later, the crash cart and team arrive from the main hospital, and start the process of getting venous access on a 15 year injecting drug user, who's had enough crack and alcohol, with no food or non-diuretic drink to seriously mess him up. After about 8 minutes of unresponsiveness, artificial respiration, and intermittent painful stimuli, and various cardiac drugs that I am unsure of, he comes around. He's disoriented, but his usual unpleasant self. They cart him off to the emerg for further tests and observation. Provisional diagnosis when he self-discharged an hour later was a malignant ectopic arrhythmia secondary to alcohol and cocaine abuse.
But he survived. The emerg doc apparently told him that if he hadn't been in my office he would be dead on the street somewhere, as she cautioned him on mixing alcohol and crack. I then no longer had to think about what I would be doing that evening, as it was spent debriefing with the staff, doing the serious untoward incident paperwork, and wondering if maybe somewhere deep down in this resus-avoidant BBV nurse lies an emerg nurse waiting to be born.

You are an inspiration, babe, whenever something like this happens I understand a bit more about why you do it.

Great post.... miss you!

Keet said...
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