Saturday, 22 November 2008

My simple act of faith

There have been those days when one takes off the scrubs and thinks "whats it all for?". A few days back now was one of those days. The day itself for the elective part was easy. I scrubbed for a case which proceeded to angioplasty which was unremarkable. I remarked to the physiologist that "if the next one goes for by-pass we will be OK for the early finish". No prizes for guessing where the next case went to. It's not a nice thing to have to say- I know that we only see the patients in the Cath Lab for a short space of time, but even so some patients find the whole idea of surgery very daunting.

It was while restocking the lab with equipment that people were talking of the possible early finish, and it was said "yes, but there is still time for a STEMI". That's S-T elevation myocardial infarction, the common or garden heart attack. This was true, and yes, there was a STEMI phoned in. Knowing that we had a bit of time to play with, the lab was made ready, doctors bleeped, nurses scrubbed, drugs opened and equipment prepared.

At first we were told a name, and they would be seen in recovery.

Then we were told they would come directly into the lab.

Then we were told they were in the hospital.

Then the ambulance crew came in at a fast pace with the trolley.

Then we transferred the patient.

I removed, with help, the dressing gown, and prepped the groin.

Then the patient arrested.

We shocked. Nothing. Drugs. Nothing.

"can somebody else CPR?" the doctor asked as the patient was big. I stepped up.

I did CPR.

A physiologist did. A second physiologist did.

We shocked. Was the charge getting through?

I did CPR. The three of us took it in turns. CPR, shock, CPR, shock. We were trying that hard to get compressions the cath lab table was bouncing up and down with the force of our efforts.

Temporary pacing wire in. The compressions kept going. The C-arm swung into place. One poor sod was trying to do CPR and their glasses ended up half hanging off. They didn't stop going.

The screening was done. We shocked. More CPR. Non shock able rhythm. More CPR, more drugs. For 40 minutes we tried, for 40 minutes 3 of us did compressions, the anaesthetic team controlled the airway, the cath lab team put lines in, gave drugs, and made every effort to save the patient.

Starting to feel exhausted, I was the last person doing compressions...when the doctors agreed. There was nothing more to do.

I stopped the compressions.

The monitors recovered from compression rhythm. Only one long line was showing. I stopped, removed my leads, cleaned up the lab. I wrote the patient labels out. I checked the date of was today's date, "whats the date of birth" I thought. Then I checked the year. The only change was the YEAR. The patient was no older then my own parents. Only 20 years older then me. Heck, proberly if they have kids they are only my age. I packed the few belongings away. The worst thing was the small bag of tablets which had thoughtfully been packed for the patient. Nobody thought that an hour before this would have happened. We tried. I was one of the first to do CPR, I was the last. One cannot help but think how many shattered lives we come into contact with, even indirectly.

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