10 December 2009

Security is an issue in the ER, and we try to be careful about it. Patients and their families have been known to stalk physicians, nurses, and other staff. Most nurses don't have their full names on their badges for that reason, and we don't give out the doctors' schedules or anything like that. I didn't think anything of it when I came in for a shift and the unit clerk told me that some patient's family member had been calling for me. They didn't say what it was for, and the clerk didn't get their name, and I shrugged it off. The next day, they had called again. Once more, there was no name or message, but it made me distinctly uneasy that there was someone out there who really wanted to find me. Who was this? Some drug seeker, angry that I had not been free enough with the oxycodone? Some process server with a notice of a malpractice allegation? One of my many female admirers? The mind reels.

The next day, once again, there was a message waiting for me. This time it was the charge nurse who had taken the call, and she had gotten some more information: it was Mrs Jones, who wanted to meet me and thank me for "saving her husband's life."

Comprehension dawned.

I had almost forgotten about the megacode of last week. I looked Mr. Jones up in the computer and saw that he was doing very well. So when I got a moment I went back up to the ICU to check in on him.

He was asleep, but his daughter was at the bedside. She was a beautiful young woman, in her late teens or maybe twenty years old. I introduced myself and we chatted; she wept and thanked me profusely for our efforts. She told me how great her dad was, and how much it meant to have him still around. Eventually the noise woke him up and he asked me who I was. I introduced myself as one of the doctors who had worked on him when he had his cardiac arrest. Too late, I saw her frantically waving her hands behind him, clearly mouthing the words, "We haven't told him!"

"I had a cardiac arrest?"

Awkward. "Um, yeah. A little one. Nothing much really."

"So what did you all have to do to me?"

"Well, we just ... ah ... pushed on your chest a bit and gave you some medicines."

"Oh." He mused a bit. "So that's why my ribs hurt."

He let it drop, and we had a nice conversation. He thought it was 2006, but otherwise was pretty oriented. A fellow Bears fan, we talked football. He asked how Jay Cutler was working out. Awkward. "He's had some good games, but a few rough ones. I think he could use some more support from the offensive line." I didn't have the heart to tell him about Favre.

On my way out, he stopped me. "So doc, was I dead? Was it pretty bad? How close was I?"

How do you answer that? It's hard to be honest when you don't want to agitate someone who is still pretty ill. I went for the euphemism: "Well, your heart wasn't beating effectively, so you were unconscious. From your perspective, it was more like a prolonged fainting spell. But you're still here, so clearly you weren't dead." One of my old professors had liked to say that the difference between fainting and dying is that you wake up. That seemed to satisfy him, and we parted.

I had given my card to his daughter, and Mrs Jones and I traded emails and voice messages for several days till we finally hooked up. She and her youngest son came by the ER and she enveloped me in a crushing hug. I'm not usually the hugging type, but in cases like this I can make an exception. She told me in very affecting terms how grateful they were to all of us. Her nine-year-old told me, in the non sequitur manner of the young, that he had just gotten his black belt in Tae Kwon Do. She told me about her husband's work, the church he runs, how he was the glue holding their family together. I told her that I was just one part of a large team that had done the work. She left, still wiping tears, promising to bring cookies to the ER for us to enjoy.

There are so many codes I've run. So many times I've told families that their loved one is dead and gone forever. So many times I've left the room to the sound of strangled sobs and tears. Bad outcomes are the rule, perhaps not surprising in a situation when the patients come in already dead or actively in the process of dying. So many times I've called the ICU doc for the admission after resuscitation, knowing that the pathology -- the head bleed, the anoxia, the sepsis, etc -- is overwhelming and undoubtedly lethal. Like many health care providers, I too become habituated to death, jaded by the inevitability of mortality, enervated by the futility of the rigmarole.

These few cases, the happy endings: they are so rare, and when they do happen so often they are so utterly unexpected, like a bolt from the blue, that when someone defies the odds and defies all logic in surviving and not only surviving but doing so unscathed it doubles and triples the delight we take in their good fortune. It reminds us not to be cynical, that though you do CPR on a hundred people, not all of them will die, so you should focus your effort and energy on the one whose chest you are compressing right now, because this might be the one who makes it all worthwhile. That's the payoff -- a dozen cases and more of suffering and tragedy for the one whose wife hugs you and promises you cookies. That makes it all worthwhile.

I have only once before talked to a person we coded on our med surg floor that actually ended up going home in good shape, but then yesterday I had a patient that had CPR done by his hunting buddies before the ambulance came. He still needs surgery, so not out of the woods yet, but so amazing to see someone do so well.Thanks for sharing your story.

Congratulations on, firstly, being humble and sharing your success with your team, and secondly, for having a great outcome. I'll bet learning of this patient's life and his family's appreciation was a great satisfying feeling.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

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