Archive for March 29th, 2007

Two stories

Two stories.

One. I’m walking into work and meet my consultant on his way in. I ask if he’d had a quiet night on call and as I said it his phone rang. Quiet up till now I suppose. So there’s a patient in the GP hospital 30 mins flight north who’s not too well and could the helicopter come and pick them up. And so that becomes my job for the morning. I grab the trolley with all the gear, enough to run an ICU in the middle of nowhere, and go to the hangar.

In Wairoa (referred to as the wild west of Hawke’s Bay) there’s a poor wee 62 year old Maori lady with not enough breath to utter a word and so sweaty and cold she feels like death. She’s now confused and wanting to stand up and sit down and then stand up again. Not a good option in a helicopter. I fill her with drugs for half an hour and if anything she’s worse. For once it’s probably not my fault.

I ring my boss and tell him the only way I’m getting her back is paralyzed and ventilated. I feel I ought to tell him cause I’ve never done this on my own before, and if I’m gonna kill someone then I’d prefer he knew.

And so I open the mini-icu in a bag and get my bits and pieces together. Now what I’m proposing to do is give an anaesthetic, play the role of the gas man. Now usually this is in a nice controlled environment with lots of flashy screens showing nice normal numbers. I have a portable monitor that would give me most of this. If it wasn’t for the fact that her blood pressure is so low that the only pulse I can feel is in her neck so I know her blood pressure’s not good. And that the probe for measuring oxygen content doesn’t work cause her fingers are so cold and the only number it gave us was 78% and I really hoped that wasn’t right.

The idea is to give her some sleepy stuff and then some stuff to paralyze every muscle in her body (apart from her heart – which is kind of stuffed already) so I can put a tube down her throat into her lungs and breathe for her.

So that’s straight forward enough, the nurse gives the drugs (half the big syringe, all the little syringe…) and she stops breathing. And the tube goes in easy enough and I squeeze the bag and her chest goes up and down. I feel the pulse in her neck and realize it’s not there any more. In my head I swear and curse that I’ve killed her. So I stick a big hose pipe of a needle in her neck and give her some adrenaline and the pulse comes back at a thready rapid rate, wait no, maybe that’s just mine. But no, it is there, just about…

And I talk my way through this in a strangely calm tone of voice, asking for this and that, betraying the cold sweat that’s just come out on me.

We stick her on the stretcher load her in the chopper while I sit at her head with my finger on the pulse and nothing to monitor except a read out of the electrical activity in her heart. And I search through the drug bag, cracking open amps of bicarb and calcium and adrenaline to keep that pulse there.

And we land and get her into the unit and I stick some more needles and drips and tubes in her. The boss wanders over and I give him the handover and he says I did pretty well even if the induction was a bit ‘vetinary’.

You see in many ways it’s easy to keep people alive. With enough tubes in the right places and enough drugs you can keep that little sack of muscle in their chest going for well past it’s sell by date. But most of the time, in cases like this it’s ‘futile’ (as I say to the family), cause they don’t get better and you never get rid of the drugs or get the tubes out.

My only comment to the boss is that it’s another successful resuscitation of a dead person.

Story two. Again, I’ve just arrived in work (it’s been a chaotic few mornings), and there’s a patient in the fire exit (our emergency extra bed space when the unit’s full) who’s just arrived. He’s been sent down from the ward cause he’s been unwell night and no one can get a needle into him to give him some drugs to make him a bit better. He’s got some horrible advanced cancer in his belly that he only found out about yesterday.

An hour of needles and x-rays and blood tests and fluid later it’s clear he’s dying. He’s in the process of having a heart attack, his kidneys have shut down cause his belly’s so swollen with fluid that they’re blocked. He can barely get a breath cause of the fluid in his lungs and the pressure pushing up from his belly underneath.

I only look at the name on his chart after the first hour’s over. I kneel at the bedside and look in his eyes and he knows his time is up, he just nods when I ask is he comfortable. I know he’s lying. I take his family into a room and sit them down and explain things. They already knew about the cancer but they hoped he might have had a bit time. I say he won’t and I use the ‘futile’ word again. And it echoes through my head that I said the same thing two days ago about the other one. And I curse myself (though I know not why) for having the same conversation over and over.

I take them back to the patient and everyone cries and I ask him again if he’s comfortable, and again he lies and I give him some morphine anyhow.

Two hours later his nurse calls me in cause he’s ‘going’. And he’s breathing his last, and it looks horrible. The deaths I’ve watched (I’ve forced myself to watch, to be there cause they deserve that much, looking away and standing outside would be too easy, cause maybe a few days earlier I’d said it would be OK and now it’s not gonna be) are mostly not peaceful. At least they don’t seem that way. The patient would have lost consciousness a long time before it happens, often uttering their last words days before it comes. But it’s not peaceful for the families. 24 hour vigils at the bedside, resolved to what’s happening but determined that they’ll not be alone when it comes.

And so this guy breathed his last with his wife holding his hand and sobbing that he was a good man and didn’t deserve to suffer. And I stand with my arm round her and let my eyes fill with tears and I pray – though I know not what. The pastor in the room closes his eyes and prays out loud in Maori and I pray along not understanding any of it except the amen at the end. I just say sorry. Sorry it had to happen, sorry we couldn’t do more, sorry it had to be this way. I prayed again, more of an empty ache for God’s presence than a cohesive worded sentence of petition.

Why do I tell you these stories? I tell them cause I like telling stories, cause the retelling of them has been in my head for days.

One of the guys I work with is a fairly thoughtful interested guy and asks why we do the job/ He asks is it cause I get a ‘jolly’ out of it? And yeah, I admit that’s true. I do this cause it’s a buzz. I do this cause in some ways it reminds me I’m alive, cause it seems important and something of significance in a world and society of mostly meaningless dross.

And I know I do it cause of who I can be. Cause of how it portrays me. And I know I tell these stories cause of how it makes me appear. And if I use ‘me’ any more in this paragraph I’ll scream.

And I hate myself for the motives in my heart for telling these stories. I used to make deals with myself that when I did something I knew would make me look good that I’d not tell people. That I’d keep it to myself, but it never happened, I always had to let it slip into conversation at some point. I hate myself for being the self-absorbed, self-referencing prick that I am. That no matter what I touch I corrupt. That the only thing I can contribute to my own salvation is my need of it.

In ‘the great divorce’, probably my favorite CS Lewis book (though please don’t make me choose…), it talks of how when we get to heaven there’ll be such laughter. Laughter at ourselves, at our histories, at how we got so worked up over so little. That we’ll laugh at our own petty little quests for significance in all the wrong places. All our self-righteous rants and arguments, how it was so important that we were right. We’ll laugh just cause we have a better view, a better perspective on our existence and purpose. Kind of like I can’t believe that I had my hair in curtains when I was 16. It seemed like a good idea at the time. I still think our parents made worse choices in the fashion department…

So why do I tell these stories? Maybe I just needed to stand back and have a bit of a laugh at myself…

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