Tuesday, August 14, 2007

Full Court Press

She was barely 50. Healthy.

Her husband woke up a little bit before 4am because she was snoring. He didn't say, but I imagine he nudged her, maybe asked her to roll over. And if this was a blog about something else, maybe she would have grumbled and flopped onto her side and everyone would have fallen back asleep and gone about their lives the next day.

But you already know that's not the case.

It's obvious when someone's coded out; there's nothing quite like the pale stillness that a lack of breathing and a beating heart brings. We georgia-lift her into the living room, and go to work.

Her heart was still quivering, a little bit, but not in any organized manner. After a minute or two of CPR, I push the yellow button on the lifepak. The whine is electronic, synthesized, a warning, rising. When it starts warbling I say "clear," unnecessarily, and thumb the red one. Unlike TV, when you shock someone in real life there's just a dull thud, as the capacitors discharge. Clunk. And they jerk.

I put a breathing tube down her throat. My partner starts an IV, and drugs start going in. The firemen keep doing CPR. Every few minutes I have them stop and look at the screen again. Every few minutes her family listens to the rising electronic whine, the "clear!", the clunk.

Eventually we go to the hospital. In the back, on the way, things change suddenly; the squiggling confusion is replaced with a familar, regular pattern, p-QRS-t, tight and clean. "Whoa," I say to the fireman who'd been doing CPR, and feel at her throat. Nothing. I press my fingers into the angle of her hip, feeling for the femoral artery buried there. Come on. There. A thready beat. I grab for the blood pressure cuff, grinning at the firemen. "Nice job, boys."

In the ER, she arrests again. More CPR, more shocks, more drugs. Back to a heartbeat. They do an EKG and see the heart attack we all expected. She needs the cath lab, Interventional Cardiology's Roto-Rooter. They come in from home. Twenty minutes or so.

She codes out again. The nurses are getting tired, so I do CPR for a while. The ER doc talks to me, as I do compressions, the quiet tones of one professional to another, talking about drugs and algorhithms. I make a comment or two back. Remind him what we gave her before we arrived.

As I sweat, pressing on her chest, the family watches from the corner of the room, and the doc orders more and more interventions, trying everything he can think of to keep her going. They take the dopamine off the pump and run it wide open. They hang dobutamine, levophed. Amio, lidocaine, mag, bicarb, vasopressin, boxes and boxes of epi. Antiarrythmics and vasocontrictors and buffers and pressors, as much as they can give.

Finally the cath lab team arrives. They take her. We clear, go and get coffee in the growing dawn, talking over the call. What an effort, we say. Full court press. I've never seen dobutamine hung in a code, I remark, and my partner nods. Rare, very rare.

It's our Friday, and we go home with the dawn. A week passes, days off, beers with friends, running with the dogs, sleeping next to my own wife. Holding her a little tighter, maybe. Sleeping a bit lighter.

On our second day back we return to the same hospital. The same shift of nurses is there. After we drop the patient, I go over to a couple. "You remember the code we brought in last week? The one we worked so hard? How'd she do?"

A pause. Their faces fall as they remember, and one sighs, ever so softly. The other nurse turns away.

"Oh," says the first one. "Her. Yeah. Well..."


Anonymous said...

As one who personally coded, full V tach, and got zapped 3 times to come back, all I can say is thank you, thank you, thank you. You EMTs may not revive us all, but hey, am I ever so grateful someone was around for me! Hang in there, you are doing great work!

Anonymous said...

Same comment as above!!! God praise you & thank you!!

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