Ok. I’ve calmed down a bit, had 6 hours of fitful, interupted sleep with sun streaming in my windows all morning, rattled around the house for about 2 hours trying to wake up enough to feel like something more than a mummy just awakened, and went for a fast (for me) bike ride through the park. Feeling a little more human again, broke down and turned on the AC. (It’s 86 degrees and humid at 8:30 pm).
So let me try this post again.
It’s easy to let self-doubt settle in when you are not constantly doing procedures or making difficult management decisions. Especially when you know that you will be doing your first night shift alone in only a few hours when all your colleagues sign out for the night. Cobwebs sift in to those corners of knowledge that are not recalled frequently enough.
But it’s refreshing to know that when you need to act, and act fast, that those skills and knowledge are really sitting there, just under the surface, ready to take control of most any situation.
So there I was, minding my own business, when the charge nurse quietly walks up to me and says, “I need you in room 5.” Huh? ME? Is he talking to me? What about thonse other 3 attendings over there…you know, the ones with a few more years of experience than I have?
I enter the room to see an older woman, unresponsive on the bed, bluish in color. I adeptly made the decision to intubate immediately. Due to her significant hypotension (systolic of 45), I elected to do so without any medications. Five minutes later and she had a 7.0 endotracheal tube secured in her airway. We were so quiet and stealthy in our resuscitation activities that no one outside the room knew what was happening. I’m still not sure if that’s good or bad. Respiratary was paged routinely, instead of STAT as a result, and I sarcastically joked if we should panic and make a lot of noise when there was an emergency. (After all, being an emergency department, there should be panic and chaos all the time, just like TV, right?)
We get her full of IV lines, central lines, arterial pressure monitors, push some antidotes that may or may not be effective, and wait. Six liters of saline later and her systolic pressure is finally over 100. But how long was she laying that way before her daughter called 911? Her heart may be pumping just fine, but only time will tell how well her brain will react to the entire episode she just went through.