Sunday night is usually bad. The nurses are disgruntled about working the last shift of the weekend, the residents who were on during the day don’t clean up as neatly as on a weekday, and the patients who were trying to wait out the weekend finally give up and come in to the ER.
I spent the first four hours handling situations that had been developing all day. The patient had been short of breath, and finally somebody noticed that they were desatting as well. The patient had been tachycardic, and the nurses decided it was high enough to be worth calling me about. The patient had been febrile all day, and now high enough to need some investigation. And the ICU patients were apparently falling apart just the same, only more so, so Brad was too busy to help me at all. Amazingly enough, everyone turned out ok.
Sometime in the wee hours of the morning, the code pager went off. I had just dozed off, and was so startled I didn’t even go to the correct floor at first. It didn’t really matter, because it was one of those “patient found down, we just noticed” kind of codes, where the patient was clearly -dead- from the beginning. No lines were called for, so Brad and I stood in the corner and watched. (Or rather, I watched, and Brad critiqued the medicine residents running the code.)
Two hours later, the pager went off again, for a room just down the hallway (yes, you’re correct, this is one of the floors the surgeons hate). It felt like deja vu, but at least I managed to get the right floor. I had the line kit opened by the time Brad arrived, but I figured he would want to do it himself, since this was a witnessed arrest and thus rather more urgent. I should have known better. Brad can be quite arrogant and abrasive (for this whole code, he was telling me things like, “What do you think you’re doing? Don’t you know how to do that? Come on, you know better than that. What are you thinking?”); but he does want me to learn. He made me put the femoral line in, and completely to my surprise, it actually went where it was supposed to go, and fast enough to be useful for fluids and drugs.
So now I feel bad, because I was just thrilled to have gotten the line in, and couldn’t even particularly consider the patient, who is no doubt dead by now. Which is really awful of me to be happy on such an occasion. But now that I know how, I should be able to manage much more easily at future emergencies. So I’m grateful, in a very weird way, to this patient for teaching me this, and to Brad for making me do the line.