This past weekend I worked 2 12 hour shifts, both of them unreasonably slow. Now I’m not complaining…On Saturday, I was able to catch up on about 21 delinquent charts from the weekend before. I set the stack of shorthand scribbled carbon copies in front of my computer and hammered them out, one by one. The night that I was transcribing unfolded before me all over again, but this time in slow motion. THis time I could see my actions before they happened. I could predict the future. This time, I saved everybody…except one.
I knew at the time it was happening that that saturday night overnight shift was a bad one. One of the busiest ones we’ve ever had. As a referral center, we got non-stop calls for transfers of critical patients. INtubated patients. Acute Myocardial Infarctions (heart attacks), strokes, overdoses, siezures, you name it, it all came to me. That’s right, it came to ME. The senior resident working a level one trauma center’s emergency department on a Saturday night. I relished it…the sicker the better…it was all great learning. Simultaneous arrivals of an intubated brain stem stroke, a man who couldn’t breathe and a college student who had been siezing ever since takign a hit of marijuana a few hours before. What was left of their brains?
I addressed the man who couldn’t breath first…he was the only one that didn’t already have a plastic tube down his throat. I loaded him with nitroglycerin, morphine and lasix. I called the respiratory therapist down to place him on continuous positive pressure breathing with a mask…one step short of being put on a ventilator. I then cruised around to the other rooms, did neurologic exams to assess what parts of their brains were still intact. I had a conversation with the husband of a woman in her mid-40s who I was certain would die. I told him the prognosis was very grim. I was the second physician to tell him the same story, and he kept grasping for hope that wasn’t there, hope that was unreasonable. Her brain was mush by the looks of the CT scan. An unfortunate rupture of a blood vessel deep in her brainstem. I went back to teh room of the man with the mask ventilation. he was smiling. HE gave me the thumbs up. The little angel on my shoulder patted me on the back. The devil on the other shoulder told me that the next woman brought in on a stretcher should have been dead. She wasn’t…but her bleed was nearly as bad as the other. Miraculously, she was awake. She answered my questions, she followed commands. But her aneurism was inoperable. I spoke to the neurosurgeon a few days later…he said the only home was if the anuerism actually grew a little more, ripened, enough that he could put a wire through her arteries, into her head and perform a little magic on her. She was only 34 years old, 2 years younger than I am.
The night continued on in this vein, and this past weekend, I got to relive every moment of it. Why had I not written about it before? Well, it all just felt so…normal. I really didn’t want to bore you with it. But as I look back and reflect, I realize that I’ve come quite a ways since starting this blog…any single one of those patients would have made a blog entry or two by themselves. Now they’re just mushed up into a single, long, forgettable night, with my only recollection of their names due to the stack of green carbon copies sitting in front of me.