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 taken three steps backwards.
Don and I 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."
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.
Someone hands me the tube, and I haul up on the scope
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.
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