Tuesday, March 21, 2006

never ceases to amaze

i'm currently entrenched in a set of nights. now that i have transferred to the wonderful world of general internal medicine from renal, the night shifts involved covering A&E which is fine. it's probably the best bit about hospital medicine when you're a junior; you're given the opportunity to see a patient from scratch and try and work out what's wrong with them. proper medicine. no wheeling patients round to X-Ray because no-one else can be fucked too. A&E is generally pretty well organised.

you also carry the "crash" bleep. if someone anywhere in the hospital stops breathing/heart stops the staff on the ward (hopefully) notice, send out an emergency "crash call" and a group of doctors/nurses (normally two doctors, anaesthetist plus others) immediately proceed to the patient who is dying.

so this morning at about 1am, sure enough a crash call comes through directing all and sundry to one of the elderly care wards. having got a good sprint on me i arrive first. there she lies, Mrs X, in her bed, mouth open, pale as someone who's obviously dead for some time. one nurse is doing some half hearted chest compressions, another is fiddling with the defibrillator (the thing that "shocks" people "back to life" on ER) and the doctor looking after the ward is puttin the defibrillator pads on the patient.

"hi," i say "what's happened?" as i take the defib pads off and put them in the correct place on the patient's chest.


thinking i'm obviously speaking too quietly "can someone tell me what's happened?"

silence. i try to locate a pulse as the defib machine tracing shows that the lady has no heart activity at all.

"that's asystole. continue CPR. does anyone here know anything about the patient?"

"i'm just doing chest compressions" says one of the nurses as i hear the lady's ribs crack.

"get Sharon!" shouts the other one.

i turn to the doctor."are you looking after this lady?" he nods and says nothing. i feel that what should be a very quick and slick resuscitation is going to be painfully slow.

Sharon, one of the other nurses, arrives and informs me that the lady was "fine" an hour ago. given that she is an icicle i stroke my chin.

anyway by the time the anaesthetist has arrived the lady has made no progress at all, she is not breathing, her heart is not pumping and no amount of adrenaline is going to make a difference. after 15 minutes and more rib breaking, we stop.

and that was that. may she rest in peace.

i wonder when i have a cardiac arrest in some horrific hospital somewhere will people be standing around saying "i wasn't looking after D&C" or "he was fine an hour ago" or will i be so dead by the time people realise that something is amiss that it won't matter.

the venial sinner has written in his last blog entry about the transiency of human existence and whether once we leave this world will any imprint of our existence be left? if that's not something to wonder about as you stare forlornly into your pint glass, then the prospect that the actual moment of your death might be so undignified certainly is worth buying a double shot over.

[i am listening to Train In Vain by The Clash]


Kate said...

That's totally why I could never be a doctor - dealing with situations like that.

You have my utmost respect

Mekon said...

So how did it come to pass? What sort of error was made - a lack of skill, a lapse, or poor planning? What protocols would you change to stop it happening again?

The Venial Sinner said...

15 minutes! You went on for 15 minutes on an asystolic icicle? Man, you should have given up on that one after one cycle and gone back to bed.

Anyway, it's normally the 6am crash call that brings you to 'an icicle' - when the nurses go round in the morning to do the observations and find all the patients that have been dead in their beds for hours.

Vegas said...

Or in one case I saw, they take the morning 'obs' on a dead person and do not realise the person is no longer of this world. At least whoever put out the call realised that someone without a pulse who is not breathing is not well.

Dazed & Confused said...

i guess it's down to the fact that there are three nurses looking after a ward of 40 over night. the doctor is covering six wards. there is no way he/she is going to know all of those patients. the nurses are spread so thinly that they can't spend enough time with all the patients. i'm not surprised that neither doctor or nurses knew anything about the patient with that staff:patient ratio.

hmmm... minimal competence and all that.

tvs: well it was 15 minutes from crash call to writing in the notes. say 9 minutes of ALS and 6 minutes trying to put the paddles on...

Psychedelicious said...

Just stumbled upon your blog today....
and such a relief to read..
to know that 'am not the only one' in deep despair the way medicine is going.
Have tried telling myself that its not me but the world which is going crazy..
difficult when you see so much insanity as part of work!
Well done, and keep blogging

cutiger95 said...

Defibrillators are an important thing for the medical industry. Having one that is a personal Defibrillator is even more important than usual if you have a loved one that suffers from a known heart condition Defibrillators can be a true life saving thing to have around.