90 Seconds in Heaven?

Today was another eventful day in the Grady ER:

An elderly lady with a possible stroke, a middle-aged man who overdosed on tylenol in a suicide attempt, a young man in diabetic ketoacidosis because he can't afford his medicine for his diabetes, and lastly, the miracle patient who came back from the dead.

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We got a call from EMS, "We're about 5 minutes away with a patient that is unresponsive and losing a lot of blood through the oropharynx(throat). We can't intubate him because he's clamped up." The physicians hurried into the CPR room to prepare the intubation equipment along with airway drugs (to paralyze and anesthetize the airway for intubation). As EMS wheels the patient into the room, the paramedic reports the patient lost about 2L of blood in the ambulance and went into ventricular fibrillation (vfibb) and they tried to shock him, but he was still in vfibb.

There about 10 people in the room at this time (interns, residents, attendings, nurses, medical students). Everyone got busy working on the patient. Someone cut off his shorts, the resident started a central line in his femoral vein, an intern started chest compressions, another resident worked on intubating him, another resident was getting an ultrasound of the heart, another resident was giving epinephrine injections, a nurse was standing by ready to shock when needed. People kept switching turns doing chest compressions. Every two minutes, they would stop compressions and check for a pulse. Every 6 or so minutes they would give a shock. After 20 minutes of working on the patient, the resident in charge of the code asked if anyone else thought that they could do anything to bring this patient back. No one said anything, and time of death was declared.

A chill ran down my spine. Through this whole process, I had been standing in the corner, trying to stay out of the way, watching everyone trying to desperately to bring this man back to life. I felt like crying (but I didn't). He was a stranger, yes, but the loss of another human life is hard.

As people were leaving the room, the resident I had been shadowing came over and asked me if I had any questions. As we were discussing the patient, we hear someone say, "He has a pulse!" With this, the activity in the room picked up again as the patient was ventilated and given more blood and fluids.

After having no pulse for about 20 minutes, the patient's heart had started to beat again on its own...a few minutes after he was declared dead.

Untold Stories of the ER

As M2s, we get to apply for an elective for the next few months. I am in "Thrills and Spills" -- where you get exposure to the ER and learn new techniques such as intubation, IV placement, and suturing. Exciting!

I started shadowing this week -- first Grady (Blue zone) then Emory Midtown. Two very different experiences.

I LOVED my time at Grady. I was working with the residents, seeing patients, high energy (while simultaneously laid back?). It was great. At midtown, I was placed in the "red pod" which is assigned to the more intermediate cases -- abdominal pain, dizziness, etc... I was also working with an attending, which created a different environment.

Among all the craziness, the thing that struck me most was patient relationships. Both at Grady and Midtown, there were specific couples that just struck a cord within me.

At Grady, an 65yo woman was rolled into the ER because she was in pain and extremely hypotensive. IVs needed to be started on her immediately. Her husband was with her, and he was SO worried. As the ER attending was rapidly firing questions at him about his wife's medical history, he tried to answer the best as he could all the while shooting concerned glances over to his wife moaning in pain on the ER bed. As she screamed while the IVs were being placed, he had to leave the room-- I think it was too much for him. You could just see how much he loved her and how much he just wanted everything to be ok. His wife had a history of MS which even further showed his dedication and love to serve as a constant caregiver to a patient with a chronic condition.

At midtown, a 60yo woman came in for dizziness. Looking up her chart beforehand, I read her history -- "hepatitis C, liver cirrhosis, coagulopathies, double leg amputation after car accident in the 70s, severe dystonia." -- this lady again was a chronically ill patient. As I walked into the room to ask her about her dizziness, her husband was sitting there was well. He helped to answer questions that she couldn't -- filling in the details of her medical history. She was easily agitated and severely debilitated by her dystonia-- not an easy patient to care for, but again, you could tell how much her husband loved her, patiently staying by her side as her loyal caretaker.

Seeing these patients just reminded me of how much I love Ben and how it would break my heart to see him sick or in any kind of pain -- really giving insight into the patient's family perspective.