My intern was calm, always calm.
The patient's mother on the other hand was unsettlingly still, watching her daughter with distant eyes. Moving her pediatric stethoscope across our patient's heaving chest, my intern closed her eyes in order to focus. Feeling uneasy about what was happening, I stared at my watch and started to count. Twenty shallow yet labored breaths in 15 seconds. Shit.
"She always goes straight to the ICU when I bring her to the hospital," the mother commented. This scene was unfolding about 11 floors too far from the ICU I thought, and tried to mentally urge my intern to pull the alarm. "Come ON Tina! She's in respiratory failure! I do NOT want to do CPR on my last day here..."
We excused ourselves as the respiratory tech came in to administer a scheduled breathing treatment. Outside the room at the nursing station our upper level resident raced over while my intern was on the phone with our attending. She opened the vitals sheet and cursed silently, then dialed in the Rapid Response Team.
If someone's heart stops, a team descends upon the "code" in order to perform CPR. At the children's hospital I was rotation at, a Rapid Response Team could be called whenever a patient is at the brink of disaster. Hopefully the RRT could avert the disaster and prevent patients from coding via timely intervention.
Timely indeed was the intervention. First 3 upper level residents arrived immediately, then a couple of cardiac fellows swung by because we were on the cardiac floor. My intern's calm presence was replaced by a orchestrated chaos, dancing around our patient with the heaving chest.
In the frenetic activity swirling around the patient, the mother was strangely calm, sitting still while observing the action. What kind of emotions were bottled up inside? Was she now simply used to the idea of death's hand constantly on her daughter's shoulder?
My attending was the last to arrive, and avoided everyone in order to walk to then squat next to the mother. He made sure to be at her level, and spoke in a slow and reassuring manner, an anchor while waves rocked the patient's bed. Soon the wires and tubing was disconnected from the walls, and the bed carrying our patient was wheeled out of the room, and to the direct elevators to the ICU. My attending remained by the mother's side, and continued his conversation with her.
When it was time to go, the mother simply squeezed my attending's hand, then shifted her gaze back to the empty space where her daughter's bed had been.
Sunday, January 30, 2011
Tuesday, January 11, 2011
Monday, January 10, 2011
Intensity
I think I've figured out why my posts dried up this past year. I like to tell stories, of people I've met and of the strange or crazy situations we've been in. For the past year and a half my routine steadily became sleep-shower-study in isolation as I grudgingly converted to the cult of lecture streamers. Why bother spending 5-6 hours at school everyday when I can speed through all of my lectures at 2.5x fast-forward in just three hours in my pj's? Nothing blog-worthy there.
If this is my last post, then you will know it was because I caught some bug from the scores of kids coughing into my face as I try to listen to their breath sounds. I've started my clinical rotations with pediatrics, and I absolutely love it. Today was my first day in the pediatric ER at the local children's hospital. I have been thinking of going into emergency medicine (just skim through some of my previous posts), but now that I am on pediatrics I'm not so sure I could go back into the adult world. Perhaps pediatric emergency medicine?
Lumbar punctures.
The pediatric ER attending delicately unwrapped a sterile tray that held the needle as wide as my clipboard. I looked at the pudgy preteen boy curled up into a soccer ball on the stretcher, then back to the needle. There was no way this was going to end well, I thought.
Instead of finding the landmarks for the needle, the attending started to screw together a strange contraption that resembled a chemistry set. The entire time the attending gave a steady running commentary of everything he was doing to keep the patient relaxed as possible. He promised to notify the patient every time any needles were involved- and to his credit he did so- all except when the humongous one finally went in. Kinda like ripping off the Bandaid at 2 instead of 3 I suppose. Anything to minimize the agony of having the contents of your spinal canal poked around.
Now I am not squeamish but I found myself holding my breath as the needle went in all directions in search of the elusive cerebral spinal fluid. Seconds slipped by and still nothing. What started as a low moan steadily grew as the poor kid's pain tolerance slowly broke down. The attending moved the needle in and out faster and faster as he checked for the clear drop of liquid that would indicate success.
Nothing. For now. Later that afternoon:
"I want you to burn this picture into your head, and never forget it." The strange wailing cry, the mottled purple of the tiny infant, and the sheer rigidness of her back was nothing like what a normal healthy baby should look or sound like. "She's getting the full sepsis work up," another attending explained to the gaggle of medical students in short white coats.
Do you remember the first time you saw an ultra-violent movie in the theaters? For me it was Saving Private Ryan. You aren't the same afterwards. Sure it is fake, but the constant exposure wears you down little by little almost imperceptibly.
I've already seen too much out on my ambulance, so for this little infant girl to give me chills, I knew something was extremely wrong. Microscopic invaders had so thoroughly conquered this tiny body that her organs were starting to give up. Starting to was the key word. If this lumbar puncture could work, our team could speed drugs through her system to combat this deadly intrusion. We were at a critical window however, and this stick needed to work.
A experienced nurse held the tiny baby in a firm motherly grip that forced the tiny torso to lean forward. She put a towel over the infant's head, then put her chin over the baby's head while holding the rest of the extremities with her hands. This must have caused explosions of pain as the diseased spinal cord and brain covering stretched out so that the attending could take a sample of the fluid that bathed the tiny brain. If I had cried as hard as the infant did I would have blown out my eyes.
Seconds turned into minutes as the needle poked around the spine, searching for an entrance into the spinal canal. Suddenly blood appeared and the doctor scrambled to hold a test tube to the open needle as precious drops of clear cerebral spinal fluid reluctantly left the body. I found myself exhaling slowly finally, and my train of thoughts picked up speed again. Okay little kids. Time to show me what you are made of. Cough all you want all over me, but I'm going to figure out how to fix you up right.
If this is my last post, then you will know it was because I caught some bug from the scores of kids coughing into my face as I try to listen to their breath sounds. I've started my clinical rotations with pediatrics, and I absolutely love it. Today was my first day in the pediatric ER at the local children's hospital. I have been thinking of going into emergency medicine (just skim through some of my previous posts), but now that I am on pediatrics I'm not so sure I could go back into the adult world. Perhaps pediatric emergency medicine?
Lumbar punctures.
The pediatric ER attending delicately unwrapped a sterile tray that held the needle as wide as my clipboard. I looked at the pudgy preteen boy curled up into a soccer ball on the stretcher, then back to the needle. There was no way this was going to end well, I thought.
Instead of finding the landmarks for the needle, the attending started to screw together a strange contraption that resembled a chemistry set. The entire time the attending gave a steady running commentary of everything he was doing to keep the patient relaxed as possible. He promised to notify the patient every time any needles were involved- and to his credit he did so- all except when the humongous one finally went in. Kinda like ripping off the Bandaid at 2 instead of 3 I suppose. Anything to minimize the agony of having the contents of your spinal canal poked around.
Now I am not squeamish but I found myself holding my breath as the needle went in all directions in search of the elusive cerebral spinal fluid. Seconds slipped by and still nothing. What started as a low moan steadily grew as the poor kid's pain tolerance slowly broke down. The attending moved the needle in and out faster and faster as he checked for the clear drop of liquid that would indicate success.
Nothing. For now. Later that afternoon:
"I want you to burn this picture into your head, and never forget it." The strange wailing cry, the mottled purple of the tiny infant, and the sheer rigidness of her back was nothing like what a normal healthy baby should look or sound like. "She's getting the full sepsis work up," another attending explained to the gaggle of medical students in short white coats.
Do you remember the first time you saw an ultra-violent movie in the theaters? For me it was Saving Private Ryan. You aren't the same afterwards. Sure it is fake, but the constant exposure wears you down little by little almost imperceptibly.
I've already seen too much out on my ambulance, so for this little infant girl to give me chills, I knew something was extremely wrong. Microscopic invaders had so thoroughly conquered this tiny body that her organs were starting to give up. Starting to was the key word. If this lumbar puncture could work, our team could speed drugs through her system to combat this deadly intrusion. We were at a critical window however, and this stick needed to work.
A experienced nurse held the tiny baby in a firm motherly grip that forced the tiny torso to lean forward. She put a towel over the infant's head, then put her chin over the baby's head while holding the rest of the extremities with her hands. This must have caused explosions of pain as the diseased spinal cord and brain covering stretched out so that the attending could take a sample of the fluid that bathed the tiny brain. If I had cried as hard as the infant did I would have blown out my eyes.
Seconds turned into minutes as the needle poked around the spine, searching for an entrance into the spinal canal. Suddenly blood appeared and the doctor scrambled to hold a test tube to the open needle as precious drops of clear cerebral spinal fluid reluctantly left the body. I found myself exhaling slowly finally, and my train of thoughts picked up speed again. Okay little kids. Time to show me what you are made of. Cough all you want all over me, but I'm going to figure out how to fix you up right.
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