It's
twenty-three minutes after midnight and I'm almost asleep. There's a rattling at the door as Aaron
comes in looking to crash out on the extra bed in my improbably large call
room. I turn over to ask him how
badly he's being hurt by the floors, for as luck would have it he had to take
sign-out on three times as many patients as I did. Just as I'm about to open my mouth, there's a set of long
electronic tones from just off on my right. I sit bold-upright, grabbing for the source of annoyance as
Aaron flips the switch that turns on all the lights in the room.
"Is
that the code beeper?"
"Sho'
'nuff. Lessee if I'm smart enough
to work it, shall we?"
I
dick around with the thing for a few seconds before I'm able to make it stop
beeping. "Ah. Here- it says 9-C."
"See
you there," he says, and turns around, taking off at a dead sprint.
Aaron
is doing his preliminary year of medicine before he takes off for Baltimore and
the Ophthalmology residency that awaits him there. We'd been joking about codes earlier in the day, along with
the third 'tern on service, who happens to be in the combined emergency
medicine/internal medicine program.
Aaron commented that he already knew everything an ophthalmologist needs
to know about codes.
"What's
that," I asked.
In
answer he raised both of his hands in the air and took three steps backwards.
Don
and I had grinned at him as we returned to gossiping about attendings or nurses, or
whatever it had been.
I
have to find my shoes and my coat (which holds my stethoscope) so I'm about
twenty seconds behind him. I get
to the room to see him doing chest compressions on a fellow who looks to be in
dire straits indeed. There are now
three people in the room. I turn
around and begin to walk away.
"Where
are you going?" He sounds
desperately unhappy.
"Code
cart. Intubation stuff."
"Oh."
Don
arrives a couple of seconds later and does what I should have done - he asks
one of the nurses to get the intubation tray out. I take it from her and start to rummage around, looking for
the tools that I'm going to need.
Here's
a number-eight endotracheal tube, and now a laryngoscope handle. There are something like eight
miller-blades for the scope. This
is nice, but I'm not terribly comfortable with 'em, so I rummage around some for
a mac, and finally find one. Now
all I need is a stylet for the tube, to keep it relatively rigid while I try to
avoid the gullet and hit trachea instead.
There is none to be found.
Don
asks from the head of the bed, "Do you want this airway or not?"
"Yeah,
but there's no goddamned stylets in here."
"Anesthesia's
gonna be on their way, man -- if you want it, you better do it now, 'cause
they'll take it away from you if you're still futzing around when they get
here."
"Okay. Shit -- no fucking stylets. Alright, I'm coming."
I
get to the head of the bed with my weapons at the ready, only to discover that
the guy is vomiting out around the mask that the respiratory therapist is using
to bag him.
Don
announces, "we need the suction please, with a Yankaur tip."
As
there's no one else to do it for him, I put the thing together and start
sucking gastric contents out of the guy's mouth. Aw man, what a disaster, I think.
I
tell the guy with the bag-valve-mask setup that I'm ready, and he shifts back
out of the way. Open up the
patient's mouth with the trademark almost-snap that the anesthesiologists
taught me, laryngoscope held correctly in my left hand. Oh, no. "I
need that suction back," I announce while placing the laryngoscope
blindly.
It's
blind because the oropharynx has a puddle of greenish-grey vomit up to the
guy's molars. I start to reach up
with the third hand I don't have to put pressure on his cricoid.
"Uh-uh,"
Don says, "I've got it. You
do the tube."
I
grab the sucker and vacuum out the guy's mouth. Suddenly I can see.
It takes a second for the anatomy to resolve into something that makes
sense, but when it finally does, I realize that I have the 'scope exactly where
it's supposed to be, and that this guy's pharynx is about as big as the
Chunnel. This should be easy,
except I don't have a stylet for the tube. O well - I'm supposed to be an expert at making do with
what I have -- here we go.
"Tube,
please."
Someone
hands me the tube, and I haul up on the scope
surreality.
I'm
in my living room working this up on an incredibly obsolete notebook rather
than the real computer (which is only slightly less obsolete) back in my
bedroom with the larger screen and the way more comfortable keyboard. The stereo is out here, you see. Loud techno-angst music going since I decided the classic rhythm and
blues that I was listening to was entire too fucking wholesome.
There's
no tv in my house, which seems to scare a lot of people rather badly - it's
almost as though they find folks without tv sets to be foreign and spooky. " . . . But what do you do when you're home?" The question itself is ample evidence
that attempts to answer are inherently futile.
Anyhow,
we were talking about surreality, weren't we? My days have this sort of disjointed sense of chaos about
them, and it's gradually starting to freak me out.
Sat
with my folks this evening working on a piece of my Mom's aetherially yummy
apple pie while they had dinner.
Came back over here and ripped through William Gibson's newest novel
(which incidentally was pretty damned entertaining) with punctuation provided
by a visit from Scheid. I've got a
bottle of Dock Street's Amber sweating onto the tabletop next to me and I'm not
going to run out of cigarettes anytime soon.
Meanwhile,
Mr. K. is back at The House recovering from his three-vessel coronary artery
bypass graft. Mr. V. probably just
finished up his evening dialysis to remove the dye we loaded him up with so we
could look the vessels in his
heart. He's got this really bad
post-infective glomerular nephritis, but we're hoping that his kidneys might
actually start to work again in a few weeks so we figure we'd rather not let
them see the dye, which might not be so good for 'em. Mrs. P went home today, rather against her will, in mortal
terror that she might some day have another exacerbation of her congestive
heart failure or her chronic obstructive pulmonary disease. She will, guaran-fucking-teed.
The
House is pretty much at capacity these days, which means that there are
something like seven-hundred and fifty folks with varying degrees of sick who
are chilling out about eight blocks from here. I can see the south tower from my window. You want spooky? That is a damned sight more spooky than not having a
goddamned tv.
But
here I am with my music and books and beer. I kind of wish that there was some young woman of fierce
intelligence and wry wit hanging out with me, but you can't have everything,
now can you?
But
it really is some kind of strange - work a trauma-arrest where some poor lady
went out on a test-drive, crossed the center-line and literally broke the
steering column with her chest 'cause she didn't feel like dealing with the
seatbelt. Pump on her chest for
fifteen or twenty minutes before the team comes to consensus that she really is
dead. Do that, then go home and
read science-fiction novels, or go out with friends and flirt with the waitress
while categorically refusing to say what we all do for a living.
Think
about it -- it all just seems incredibly bizarre to me. Am I missing something?
Still
. . . I wouldn't trade it for anything.
Anyway
for what it's worth, I got the tube on the first try, even without a
stylet. Don got a working line in
the guy's external jugular vein; a piece of very strong work.
The
patient responded beautifully and is now back out of the unit and talking . . .
Heh. Not really. He died. He was
probably pretty dead when the code was called, but we sure as hell did our
damnedest to bring him back; no dice.
After the rest of the team had dissolved, I sat with the upper-year
resident who ran the code while she called the attending. I listened in amazement as he tried to
persuade her to call the family so he wouldn't have to deal with it.
"Oh. Yeah, uh-huh. Well, I don't know anything about the patient at all; I just
ran the code. No. Yes. Right. If you
really don't want to call them, I'll take care of if for you, I guess. You will? Oh, I see.
Yeah, I'll be here for a while.
Sure, you can have them call me.
Uh-huh. Yes - thank you,
sir."
She
hung up the phone and suddenly looked very tired.
I
was livid. "That wasn't what
I thought it was, was it?"
She
looked at me, said nothing.
"Jesus
Christ, what a fucking pussy. That
is just fucking incredible."
She
just shrugged and started looking through the chart some more, then stopped and
looked up at me. "You did a
good job. Nice work with that
tube." She turned to the nurse
who had called the code, who was looking desperately unhappy. "You did great -- you did
everything right. This was not your fault, so try to stop blaming yourself,
okay?"
A
little while later I stood up and touched her shoulder. "Thanks, boss. See you later."
I
went back downstairs to my call-room, adjusting the blinds so I could take in
the view of Downtown Pittsburgh.
Beautiful. Stared out over
the city for twenty minutes, then tuned the tv to a dead channel with the
volume clear down so there would be some light in the room if my pager went
off.
I slept just fine.