WhiteCoat

Thank God

As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial.

“Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every chance we get.

When she turned around, the look she gave me signaled that it was no time to joke. Tears were running down her cheeks.

“What’s …?” She cut me off.

“Thank God you’re here. Get into Room 7 now.”

When patients are really sick, it has been said by people much smarter than me that your worth as a physician can be judged by how people invoke deities. There are the “Oh God” docs and there are the “Thank God” docs. Being classified in the latter category by a nurse whom I admire is a compliment, but it also meant that there was something very bad behind the curtain across the hall.

I set down my bag, unzipped it, and searched around for my stethoscope. The nursing supervisor grabbed my shirt and pulled me toward the room. “Use mine,” she said.

She threw open the curtains and it took me a second to size everything that was going on. Despite the commotion, it was eerily quiet. In one corner, a middle aged man and his wife were sitting holding each other’s hands. Both were crying. An ambulance stretcher was pushed to the side of the room. EMTs were trying to start an IV on one arm. Two nurses were working on getting an IV in the other arm. At the head of the bed was the respiratory therapist. He had a brow full of sweat and kept wiping his forehead with his arm as he worked the Ambu bag. He told the doc who had her stethoscope on the patient’s chest “I’m barely able to get any air into her lungs.”

Laying on the bed was the limp body of a 13 year old girl. Her color was between dusky and blue.

“What’s going on?” I asked.

“Bad asthma. She just stopped breathing on the way to the hospital,” said one of the EMTs.

“We can’t tube her because her jaw is clenched down and we are having trouble bagging her because she’s so tight,” the other doc explained further.

She was from an outlying area, so her transport to the hospital took 25 minutes. She was in respiratory distress when EMTs arrived, so there was at least 30 minutes of ineffective respirations.

“What has she gotten so far?” I asked.

“Nothing, we can’t get a line,” said one of the nurses.

I grabbed the nursing supervisor. “You need to go get epi NOW.”

She walked out of the room and said over her shoulder “I was doing that when you walked in.”

I watched the respiratory therapist try to ventilate the patient. The problem wasn’t that her lungs weren’t getting enough air, the problem was that her lungs were full of air and the airways were so constricted that the air couldn’t get back out.

I went to the side of the bed and started squeezing the patient’s chest between ventilations to force the air back out.

“IV in!” Announced one of the nurses.

Medications started pouring into the IV line – to improve the patient’s asthma, to sedate her, and to paralyze her muscles so that we could put her on a ventilator.

I looked up at the respiratory tech. Sweat was forming a triangular wet spot down the front of his shirt.

I prepared to insert a breathing tube and pressed down on the patient’s jaw to insert the laryngoscope blade. Her mouth filled with vomit.

Dammit.

We lowered the head of the bed so that the vomit would pool in her mouth and then suctioned her. Her oxygen saturation started to drop. We Ambu bagged her again. More vomit filled the mask.

Dammit.

We suctioned her again.

“Do you want me to call anesthesia?” asked the nursing supervisor.

“No. I can do this.”

“Are you sure?”

“Yes. She just needs to stop vomiting.” The tone of the beeps on the oxygen monitor became lower and lower – meaning that the patient’s oxygen level was getting lower and lower. Now I could feel the sweat building on my forehead.

With some additional suction, the airway was clear and I got the tube in place.

The beeps on the oxygen monitor began to rise in tone. Everyone in the room breathed a sigh of relief … including me.

As the respiratory tech taped the tube into place, a few drips of his sweat dripped onto the bed. I looked over at him. His whole shirt was soaked. He looked like he had just walked out of a sauna.

The secretary came into the room and handed me results from a blood gas. The pH was 6.7 and the pCO2 was greater than 100. Not encouraging.

The patient’s parents looked up at me. I tried to be upbeat. With a half smile I softly said “She’s doing better now.”  On the inside, I wasn’t so encouraged. With her prolonged down time and that ABG, I wondered whether she would ever wake up.

We arranged transport to the regional Children’s Hospital pediatric ICU and within a half hour she was lifting off of our helipad. By the time she left, the sedation and paralytics we gave her would have worn off, but the patient still wasn’t moving.

All I kept thinking about was that this could very easily have been one of my daughter’s classmates – or even my daughter – who was only a year older than the patient. I had to stifle the urge to call home just to make sure that everyone was OK. It was 12:30 AM and giving myself peace of mind would only have created a whole lot of angst with my family.

About three hours later, we get a phone call from the Children’s Hospital. The physician wanted to give me an update about our patient. By that time it was almost 4:00 AM. The physician on the other end of the line sounded exhausted.

“The transfer that you sent over here …” During that small pause that followed I could already feel my face getting flushed. For some reason I suddenly had this overwhelming sense of grief.

“Yeah …?”

“She’s already awake and trying to pull the tube out. Looks like you guys saved her life.”

All I could muster were the words …

“Thank God.”

35 Responses to “Thank God”

  1. DaveyNC says:

    Thank God.

  2. WarmSocks says:

    Wow!
    1) Good work. You saved her life.
    2) Fabulous piece of writing.

  3. Chrys says:

    You had me holding my breath and feeling for you all. Great job!

  4. MichelleC says:

    Don’t you ever stop writing. At least, not until MY eyes have become to weak to read your blog. Thank God indeed.

  5. MichelleC says:

    [too]

  6. DefendUSA says:

    Goosebumps.

  7. Christine says:

    what Chrys and WarmSocks said. Great job!

  8. Christine says:

    Excellent post.

  9. PJ says:

    Wonderful. Strong work by all involved. And additional kudos to the doc at the Children’s Hospital for the follow-up call.

  10. Marilyn says:

    **sob**

    Once in a while there is a happy ending.

    It’s worth working for.

    Nicely written, and well done!

  11. hashmd says:

    This makes up for all the dirtbags you have to see (and keep) in your ER. Great job.

  12. HOWsMom says:

    That gave me goosebumps.

  13. Richard Cardosi MD says:

    Wow! Nice work. you put me there, but I’m glad I wasn’t.

  14. Steve says:

    Putting one in the win column every once in a while is why I do this job…great post…

  15. Danimal says:

    Ditto — compelling writing, and a damned good job. I can’t imaging what that would be like.

  16. CholeraJoe says:

    Good save, man! In 25 years of Critical Care medicine, I’ve only had a handful that pulled out as good as this one.

  17. SeaSpray says:

    Goosebumps!

    “She’s already awake and trying to pull the tube out. Looks like you guys saved her life.”

    I felt goosebumps when I read that.

    Good job WC!

    Thank God!

    I felt like I had a birds eye view with your description of the events.

  18. Hope says:

    Wow. Just…wow.

  19. RC says:

    I’m with WarmSocks. Amazing piece of writing… you bastard.

    *Insert my husband across the table mocking me for crying over med blogs again. I made him read it too.*

  20. Nurse K says:

    That’s the patient that I tested on in ENPC class…

    They would have failed by not putting the IO line in (after two failed attempts at peripheral access) and by not suctioning the airway. Oh, and the patient’s tongue is ALWAYS blocking the airway and you ALWAYS put an oral airway in and ALWAYS decompress the stomach with the NG tube post-intubation. :)

    Good job, WC.

  21. Chelsea says:

    God was there with you all bud. Good work. Hope there was no lasting damage. Had a friend/coworker who died from asthma not getting to hospital in time.

    • mandy says:

      With all due respect, where was that same God when your friend died? It makes no sense to me to give God the credit for saving this girl’s life, but not blame him for taking your friend’s life. I’m sorry, but the writer and his staff saved that girl’s life. They deserve the credit!

  22. Jeff says:

    I’m so glad this turned out like it did. It could have been much different. It’s always easier to Monday morning QB than it is when you are in that situation. And I have been in them, still, I can’t help but wonder why the EMTs didn’t administer SubQ epi before she went down the tubes? Did they just not think of it? It really could have made a huge difference in her care and does not require a line. So many times you tunnel in on tubes and IVs and medications when a quick sub Q epi may be better than any of those. There is little down-side with such a young patient. Just curious why they didn’t do this.

  23. Kyla says:

    Wow. Excellent save, I’m so glad it turned out well.

  24. ERP says:

    The only tube that matters is the one that matters (so to say if you know what I mean) – strong work.
    This is what our sole purpose of existing is. We need to be able to save people that are savable. We need to be the closer or the kicker who makes the 56 yard FG to go into over time. We train to be that guy. All the other crap is something every other doc should or can to. We need to be the clutch player. If we are an “Oh God” doc, we need to change careers.
    Top notch work WC (both in tubing and writing).

  25. ER Doc says:

    awesome writing.

    that’s what this job is all about. through all the BS…through all the long nights…that’s what we are there for. Those are OUR patients. way to go

  26. type1medic says:

    Amazing! It is cases like this that makes the job worth it. Great job!

  27. totalfailure says:

    that made me happy. and made me cry

  28. ER Murse says:

    This is what it’s all about. This is why we do what we do. It isn’t the seekers and the whiners and the paineurs and the ‘gimme a sammich’ crowd. It’s the chance to help save a life, and give someone back their future. Thanks for being there.

  29. tracy says:

    Fabulous work!

  30. Painless says:

    Awesome job WC! Hell, to be honest that story made it worth all the garbage I saw and had to keep in my ED yesterday.. that’s how strong that was. Kudos to you and your team!!
    Hated that you all were in the situation, but glad it was the right people at the right time at the right place.. again very well done!

  31. Miss Chevious says:

    Awesome job…on the writing and the lifesaving! You rock. Love your blog.

  32. Chris says:

    Thank God, indeed. I was starting to sweat reading that.

  33. Taj says:

    ‘Oh god EPs’ and ‘Thank god EPs’. That’s a GEM!. I’m making my own 2 column spreadsheet table, self reflecting …hope it tips over to side which is favorable.

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