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]