Whatever white cloud I once had, it is definitely gone now. My chief is beginning to be over-satisfied with the number of consults I pick up when we’re on call.
Yesterday, the chief called me: “I’m about to scrub in for the next case, but I was just looking at a patient in the ER. He looks pretty sick; his white count is sky high, and his heart rate was at least 140. The ER says he has cholecystitis, but I don’t quite believe them. [our ER's ultrasounds are notoriously unreliable] If he does, he should come to the OR next. Go figure out what exactly is going on, sort it out, and let me know.”
I was on the other end of the hospital from the ER, so I started walking. By the time I got to the ER, there was a certain electricity in the air – literally. The charge nurse looked up from the front desk. “Whoever you’re here for, they need some help in 5. They’re having a code.” 5 was where I had been heading.
The code went on for an hour, increasingly pessimistically, but it was impossible to stop till we were certain. Usually, in a code, the patient has no cardiac rhythm whatsoever – asystole; and in that case the protocol calls for compressions and drugs, but no defibrillation. This patient remained in vfib forever; and we defibrillated over and over – enough to satisfy any ER junky – to no effect.
Finally, after we called the code and the ER doctors had started trying to figure out contact information, I went up to the OR. “I’m afraid that patient coded. We did CPR for an hour, but we couldn’t get him back.” The chief cocked an eyebrow at me. “I told you to take care of things; I didn’t mean you had to do it that drastically.”
That was one code I found it impossible to feel too badly about. If the patient was sick enough to code in the ER, he would not have survived surgery. Moreover, you don’t develop cardiac arrest from acute cholecystitis, even a severe case. There must have been something else going on.
On the other hand, that makes three patients I’ve lost in the last week – more than in the previous six months together.