Stat!

"Staff Stat to OR Z"

Hmm.... not good. usually.

This is an alarm system we have so if there's anesthesia emergency and the staff is not in the room, the resident or a nurse can call overhead on the speakers and everyone available can come to the room to help whomever is in there.

Sometimes it's only a false alarm, the patient's oxygen level is reading a little low and the resident gets a little worried.

Sometimes it's much worse.

"Staff stat to OR Z"

I shuffle quickly over there.

I walk in, they are doing chest compressions. Apparently the patient "crashed" about 10 minutes after the start of the case.... low blood pressure of uncertain origin, didn't improve with treatment at all so they started CPR (Cardio Pulmonary Rescusitation). Emergency drugs were given.... epinephrine, atropine, all the good stuff.

After about 15 more minutes after I arrived, they called it, meaning they pronounced the patient dead, all attempts unsuccessful to resuscitate failed. The anesthesia staff in charge of the case don't know what the issue was... the patient was "relatively" healthy. Definitely will need an autopsy to see if anything obvious shows up.

Anyway, we all shuffle out, mostly feeling defeated a little.

Ten minutes later,

"Staff stat to OR 10"

Weren't we just in there?

I head back over there. They're doing chest compressions again.... apparently they were cleaning up the room and filling out the death packet and they saw some rhythm on the monitor so they felt they should give it another shot. Although in the meantime, they hadn't been ventilating the patient or watching the patient since she were pronounced dead. (why would they?)

We persisted a few minutes and then we all decided that it was probably futile... some sort of agonal near death heart reflex (which often happens).

We all left the room again... though not before I disconnected the monitor.

Sadly we can't win them all.

death in the or

Somehow as morbidly ill someone is when you are in charge of their case, as little chance as they had of surviving.... you can't help but take it a little personal when they expire in the OR.

More later... maybe.

Avoiding the pain of death

Got a call this morning from a friend. One of her patients had died. She was distraught to say the least. She is a resident in an obstrectrics/gynecology program. Her patient was having a baby by caesarean section. Apparently she went into some sort of respiratory distress, and did progressively worse. It was my friend's second death as a physician. She specifically told me that she went into OB/Gyn just so she wouldn't have to deal with death. I honestly had nothing to say to her. First of all I don't know how to talk to crying women. Second of all, She really had a right to be upset, there's really nothing to say. She really does put herself into her job.

This has been much different from my experience. I of course am in a different field. There is much more "volatility" in anesthesia. We deal with critical patients all the time. I, myself, have had particularly bad luck in this respect. I watched one of my patients bleed to death on my first day of anesthesia residency. It was very traumatic. I considered not coming back for a second day. Then I realized that was part of the job that I come there to do. I still remember that day vividly. I don't think i've had a case that bad since. I also had a patient die my first call as a attending staff. We did everything we could to keep that patient alive for three hours, but nothing helped. That was also very "character-building".

So how do we avoid death as physicians? The only way I can think is to avoid taking care of patients. I could quit tomorrow to drive a cab or work at Blockbuster. At what cost? I could throw away years of schooling and hard work, I could throw out the desire to practice good medicine. Unacceptable. I enjoy my work, but as a result I need to be able to deal with death. Hopefully not very often though.

My friend needs to learn this too... I think she'll come around. She's worked hard to get where she is... unfortunately she's pretty miserable these days. Hopefully as she gets further into her residency she will enjoy her work as much as I enjoy mine.

Death

I'm watching a documentary filmed at my hospital a few months ago. I've written about it a few times in the past. I've critizized it for being a bit melodramatic and ignoring anesthesiology. That's all okay. Today the showed someone who almost got a liver transplant twice and had it unable to be done for various reasons. Then they showed him dying after having life support withdrawn at somepoint after that. I think they did a great job actually showing that not everything turns out well in the hospital. Not the usual perfect outcome that's usually portrayed. Even though I've seen death in the hospital before it still hits you. Rest in peace.