Saturday, February 10, 2007

Almost a Code

We have a very unfortunate patient on our service. She's a very pleasant lady with diffuse scleroderma, systemic, and many complications thereof. She keeps filling her lungs with fluid, which makes her desat and gives her tachycardia. She's on TPN because, as one intern put it, "her GI tract is like a garden hose." In medical terms, she's a real mess (and I don't mean to be insensitive, or mean any disrespect to this poor woman.)

Every day since assuming her care, my resident has said "she's really sick, she could code at any minute." My resident is OBSESSED with coding. He's always talking about "when you're the resident, it's just you and God, it's you and the patient and life or death." I understand his obsession, but it's scary enough picturing myself running a code without someone constantly hyping them to me.

On Friday, we were *finally* rounding, around 11:30 am, when our resident got a page. He made a phone call, grabbed his papers, muttered "Mrs. X is unresponsive" and dashed out the door. Since I'm apparently the only person on my team who actually listens to anyone else on the team (a topic for another post), I was the only person who heard this. I stood up and started to grab my stuff. My attending looked up, puzzled. "Where'd the resident go?" I think I said at least three times "Mrs. X is unresponsive, he went to see her" before he understood. The whole team packed up and headed out the door.

We eventually made it to her room, where my attending turned into a snarling bear. "Why doesn't she have a blood pressure yet?! That should have been the first thing you did! Where is anesthesia? Why haven't you intubated her yet?" Repeat ad nauseum, and you get the idea. Mrs. X was indeed sick, but alive, and not a "code", so we were able to eventually intubate and transfer her to the MICU, where a bed mysteriously opened up for her.

Worst parts of the whole experience?

  • My attending bitching everyone out, then sitting in the corner pouting. An honest-to-god, actual POUT was on the man's face.
  • Waiting 30 minutes for anesthesia to show up and actually intubate the patient. Respiratory therapy couldn't do it, as her mouth only opened about 1.5 cm due to her scleroderma.
  • Listening to the rapid response team girl talking on the rapid response phone: "Yeah, I'm pretty hungry. I haven't eaten ALL DAY. I was down in the cafeteria, talking to some people, when I got the call." Blah, blah, blah, ON THE FUCKING RAPID RESPONSE PHONE. Thank god none of this lady's family was present.
  • There were so many people in the room that confusion was rampant. "What's her name?" asked the anesthesia resident. "Mrs. Y" shouted one nurse. "Mrs. B" shouted another. "Mrs. X" shouted our team. Oh my god, people, if you don't know the patient's name perhaps you shouldn't volunteer the information!

Worst part of all? Standing by the wall, feeling helpless and hungry (I hadn't eaten ALL DAY either, bitch!), knowing there was nothing I could do to help, and praying she didn't actually code.

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