Monday, December 24, 2007

Hey, Hey LBJ, Ruin Christmas For Me Today

Clearly, for LBJ, read Shroom; but that don't rhyme.

Last two shifts have been hellish. Busy, busy, busy, punctuated by flail and trauma.

A patient bought beer for the ED staff, however, and I intend to finish my shift drinking one in the Ambulance Bay. Merry Shrooming Christmas.

Tonight, my last for a few days, was eerily quiet. Quite nice, actually; but a quiet department makes me nervous. It's superstition, I know, but I also know it means something shit is waiting.

Tonight was no exception.

Having begun to think that we might make it through, actually having an entire shift that was nice and quiet, the BatPhone trilled into life. While this usually means someone unwell, we do get a variety of stuff phoned through. If you're dying, you'll come through on the phone, but if you come through on the phone, you ain't necessarily dying.

First, a cardiac arrest. I'm embarrassed to say that I can't remember how old he was, even though he slipped away from us less than an hour ago. 70s, I think. The crew that brought him had been going an hour, with no encouraging signs. There's really no comeback once you've been dancing with the Angels that long, but we'll try. The team is ready, and eager; callous though it may sound, it's also a good opportunity for the juniors to try their hands at running an arrest.

Another 30 minutes with us and we were finally ready to accept what we all knew was true. So my SHO got to learn the art of breaking bad news; this time of year it seems especially cruel.

As we were getting our breath back, the unwelcome trilling rang out again. Another gent, 70s again; bellyache, low blood pressure, poorly responsive. Time only to wipe our brows and breath in.

When he arrives, I can see he's in trouble. A raven might as well have been perched on his shoulder. He had apparently gone off as soon as the Ambos arrived, slipping into unconsciousness, and abandoning all attempts at breathing. His pulse, fluttering, weak, thready; barely evidence of a tenuous hold on life.

It didn't last.

Within minutes, he was gone. We were still gathering obs, still trying to make sense of the puzzle before us when he lost his fight. CPR started immediately, and I tubed him; slick as you like - Grade 1 view, some airway soiling, but the semi rigid, impersonal endotracheal tube whipped between his cords as easy as you like. Forcing air into him desperately, I couldn't tear my eyes off his belly, which was blowing up in front of our eyes.

For a few frantic, soul searching moments my 'satisfaction' with the tube turned to self doubt.

'It's in his fucking oesophagus...'

Then the CO2 monitor lit up. CO2 only comes from the lungs, so the tube couldn't be anywhere else. I think that might be called 'cold comfort'.

Another undignified struggle. Nothing made any difference; every intervention a small victory, but in a losing campaign. As is so often the case, all the cajoling, all the pleading in the world, couldn't get his heart started.

My turn to talk to the family. The usual explanations; the apologetic, quietly spoken words. I don't know how they hear them, but they echo dully in my own head.

And finally, they take it in, for now anyway - tomorrow will be different, and the next day, until the realisation finally takes root - and they thank me.

'For all you did for him'

For ruining Christmas

2 comments:

Lala said...

Sorry Shroom, hope things pick up. Happy Christmas.

Chrysalis Angel said...

Sorry such a rough go of it Shroom.