Sunday, January 31, 2010
The End of the Road
So last night I'm standing on a foot stool in the ICU, bent over this guy whose skin is gray with death, and I'm totally not doing his chest compressions by the book: I'm not counting how many times I push in his sternum either out loud, or to myself. I'm just pumping away while the Canadian charge nurse (who reminds me of my mother so much that instead of an Toronto accent, I keep expecting her to talk with a Hungarian accent like my mom) writes notes on her clipboard, recording every detail of the Code Blue. The red-headed kid in a fleece sweater standing at the foot of the bed is the ER doc. She has abandoned the emergency room patients to respond to the code. I glance sideways at the patient's monitors, marveling at how every time my hands push in his chest, the monitors show how I am causing blood to flow through his body.
The ER doc notices a blood spot on the patient's thigh. It's coming from his groin, but no-where near his reproductive organs or rectum, so I ask out loud, "Did he have a femoral line?" A tiny Filipino nurse (the very reason why I'm the bozo doing chest compressions: something the average American isn't aware of is the fact that you 5'9" 300 pound Anglos are at the mercy of 4'9" inch Filipino nurses who weigh 100 pounds to do your chest compressions when your heart stops) says "Yes, it was removed 24 hours ago."
"Twenty four hours ago, and it's still bleeding?"
No surgical wound, injection site etc should ever bleed 24 hours later.
The ER doc (did I mention that she's the youngest person in the room?) says, "Oh yeah, his liver functions are a disaster--history of hepatitis."
Glancing up from the fresh blood trickling out of the guy's thigh, I look at Lisa, the 6'4" respiratory therapist, and say, "Yeah, that's what happened to my mom, when she had her stroke. She caught hepatitis in the sixties, working as a lab tech, and when she had her stroke in 95, her brain kept bleeding all weekend long. They couldn't stop it."
A chorus of "Oh, shit!" is shouted in response to my story, then the ER doc's voice from the foot of the bed says, "Tweny more of bicarb." The tiny Filipino nurse does as ordered, and the ER doc says, "Stop compressions."
My back is happy to hear her say that; I stand up.
She looks around the room and says, "Time of death is 10:42. Does anybody disagree? Does anybody have any objections?" She looks around the room, and makes eye contact with each one of us, one person at a time. We all agree.
While we filing out of the room, so that a nurse could clean the guy up before they let his wife in to say goodbye, the tiny Filipino nurse says, "He's smiling. Are smiling, John? Are you happy, now?" The guy wasn't smiling, it was a death grimace, with his jaw gone slack, and she wants to turn this into "Oh look, he's going to Heaven to meet Jesus, so he's at peace." I was appalled on so many levels.
That was how the shift ended, in contrast to the beginning of the shift, when I did a STAT portable chest x-ray on a boy who had been born an hour ago, and was breathing funny. I set up the portable next to his incubator, and while I was sliding the cassette underneath him, the naked, pink, fuzzy little guy took in a deep breath, and let out a holler.
I looked at him and said, "You don't need a chest x-ray, you sound great."
We had a baby boom, yesterday: two sets of twins, and the kid that I x-rayed.
And so it goes.
Woke up this morning with a sore throat, feeling like I've been run over by a truck. I'd promised the wife that I'd go up into the mountains with them, so I walked the dog and got dressed while the wife did all the work packing warm clothes, the food, and the kids into the Jeep.
Got up to Wrightwood, and kept going on up the 2 to a part of the San Gabriel Mountains that I love to hike in the summer. They only plow the snow off the road up to Vincent Gap, and if you look at the photo with road signs sticking out of the snow, you'll realize that's Highway 2, buried under several feet of snow, as it is every winter. Yes, this is in Los Angeles County.
Mount Baldy (it's legal name is Mount San Antonio, but most people don't know that) at almost 10,000 feet, is barely in San Bernardino County. We see its south slope every day from our house in Claremont, but it's neat to see it from the north side.
I'm glad I went with the family, but the cold that I have reared its ugly head, and I hit the wall (how's that for a mixed metaphor, Professor Higgins?). We got home, and I dragged myself to work. Knowing that I wouldn't last through the shift, I called the back-up tech, and went home as soon as she got there. Instead of going to bed, I've been watching an awsome movie titled "Frozen River", about a Mohawk woman and a white New Yorker who wind up working as smugglers across the US-Canadian border. I can't recommend this movie enough. It's excellent. Well, off to bed. I better check the medicine cabinet for NyQuil.