Sunday, April 27, 2008
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Conflicted with Authority
Perhaps it's simply the fervor of youth, but I feel like some ER Physicians give up a bit too easily. As I'm on the code team, I see alot of things go down. Yesterday we had this woman bradied into respiratory failure and ventricular tachycardia while she was undergoing and endoscopy procedure. I knew she has a tension pneumothorax, but other than that no details. She was also a dwarf/midget, so I'm guessing she was just in a generally unhealthy disposition.
It was actually a rather small team as 4 of the 8 people were doctors. After we had worked her back towards a normal sinus rhythm, none of the particpating doctors could intubate her. Nobody could establish her airway at all, they just kept aspirating her stomach. Granted, she was a midget with odd anatomy (almost no neck) and she had a tension pneumothorax causing her treachea to arc, but seasoned ER Doctors should be able to intubate someone in their sleep. None of them could simply do it. None of them used cricoid pressure, and they even had a SCOPE, yet she couldn't be intubated.
After 10 minutes without oxygen, they should have done an emergency Cricoidostomy, which they only mentioned after 30 minutes had passed. In the meantime, he kept saying how there was nothing they could really do for her. I asked why they simply didn't use a pediatric combi-tube, and one of the nurses replied that they couldn't because of her strange anatomy. This made absolutely no sense to me, but I could tell there was going to be no arguing. At that point I talked with the primary care provider (MD) about inducing hypothermia and using K+ channel blockers to reduce the oxygen demand while he tried to establish her airway. He liked the idea, and we implemented it.
So we're slightly over half-an-hour into the code and still have no airway. Her heart occassionally slow to a stop and has to be brought back, but is easily done so with CPR. Despite the lack of oxygen, she's giving one hell of a fight. I was so proud of her. Finally, when it came time to use the cricoidostomy as final resort, the ER MD said that it would be too difficult for him to do and that we'd need to call a trauma surgeon to perform it. That's utter bullshit. I could have performed the "cric" but don't have the scope to legally/medically do so. I was getting irritated inside during this code.
So 45 minutes later she's having trouble keeping her heart going but she's still kicking. The husband arrives on the scene and one of the doctors convinces him to let her go after he refused twice because even though she was alive, she'd probably be brain dead. The worst part was that the consent to cease was given right as the trauma MD walked into the room. I had to contain my irritation. Even though there was a probability of serious damage, she was being so resiliant that a near-full recovery could have been possible. At the very least, she could have been taken off life-support at a later date if that were so. To tell the truth, if he had just established an airway, she would have only needed supportive care. She should have fucking made it, but that ER doctor just reeked of a quiter to me. She was on the ropes, but still very much alive if you ask me.
I felt so awful leaving that code. Not simply because life was lost, or that I felt it was needlessly so, but her husband was a double-amputee (legs) and thus in a wheel-chair. Typically with disabled couples, eachother is all they have. Now this poor guy who probably has had a rough life as it is will forever be alone because the ER Doctor was a fucking quitter, the Endoscopist was incompitent, and the primary care was too timid to make any real decisions. I'm still amazed that he responded to my suggestion.
Way back when I took my first medical lisensure class (EMT-B), my instructor (a seasoned Paramedic) told us that the only way to move past losing patients is if you did everything within your power and ability to save them. I don't think this was done, but with so many doctors around I wasn't really in a position to say much. In the hospital, doctors are law--even when they quit. This is the third time I've seen doctors just not give a shit.
The prestige and title is nice, so is the reliable note-worthy income, but those are merely perks--not the reason you practice medicine. When I'm finally an ER MD, I am not going to quit anybody no matter who they are or why they are there. That is the job, and it's what you do. At the very least I'll then have the authority to tell anybody with a different opinnion about that to get the fuck out of my ER.
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Comments (9)
If I had my way, people would have to write an admission essay almost identical to that just in order to get into Med school. I wish all of them had their heart in the game.
P.S. I do know (somewhat) how you feel...I've worked as a Medical Assistant and been through EMT school, and sometimes it' s just....
"The prestige and title is nice, so is the reliable note-worthy income,
but those are merely perks--not the reason you practice medicine."
+100 awesome points.
I have a couple friends doing the EMT/nursing/med-school thing, but all they have to say about is that they want to fatten up their wallet, get free health insurance for their kids, or that it's really funny watching people croak.
RYC: No offense taken, preach away. :)
As far as dropping out goes, I was fifteen years old, and infected with the elitist-"I know everything, fuck authority, fuck the system" disease that's an epidemic with teenagers. Not being able to afford college is the simplest reasoning I could think of to tell people, but being able to learn things I actually wanted to, things that would be applicable to my life without having to sit through 2 more years of AP bull was definitely up there.
I think we're both arguing the same point in a way, just from different situations. "It's what you do with your education that matters." Precisely! All the courses I have taken and are taking currently are productive to my career. The past fews years have been spent developing my photographic career, and all classes related to that weren't for the purpose of running around with a degree to rub in the faces of potential clients, but rather to further understand entreprenurial small business, and learn how to play the market, something that's often over-looked in art schools, leaving graduates with a shiny portfolio and a diploma but not much else.
In the next few months I'll be a certified student teacher/substitute, and next year I'll probably get all my GE courses out of the way, before going on to a State school (probably) to finally get my teaching creds. It makes more sense to me to--as far as money goes--spend a couple hundred bucks to get the *boring* stuff out of the way, and then make the investment in an actual university to finish up and get a degree I'll actually use. So many people I know go off to college right out of high school, putter around, and don't know what they want or want to do. I feel far too much importance is placed in that little sheet of paper, be it from high school or college, and people far too often overlook how to actually function in the real world.
My father is the best paramedic in NY. He's now Chief of Paramedics and an instructor, and I have gone on the job with him many times. Hah, it's a tad bit odd that I completely understood all of the medical procedures you described, and the terms you used. It is unfortunate for the woman, but you have to remember: your desired orders were not carried out; they were refused. YOU fought all you could, and there is nothing more that could have been done. Take comfort in that, and let her go.
I think whenever people's lives are involved, it's always tricky. It is sad that a lot of doctors don't seem to be compassionate anymore. But I am so glad to see that you're fighting for what's good and right. =)
So this one made me cry.
There's a reason why you're working where you are, especially since your heart is in it. I have a cousin who's an MD in the ER and she's so cold towards the loss of life. I think part of it is a coping mechanism in detaching herself emotionally from the patient/situation (one of the reasons I could never work in a hospital)....but it makes me wonder if she was placed in the same situation what she would have done.
Very good stuff. I was just stopping by- but I think I'll subscribe. :)
~M
Wow - I haven't been on here in awhile, but appreciate your writing this. You can be my ER doc anytime.
hey so ur into medicine...i didnt know, i dont know why i thought u were an architect ...lol yea my mind sometimes doesnt work, well all i can say is that ppl over there must be proud of u, i really dont know how medical care works all around the world ..overhere its bit crappy at times ..has its bad n good side n theres always ppl who work just cuz of the money n no cuz of they willing to help ...n well among other defects i suppose since everyone isnt the same ...luckily theres still ppl who is willin to give all the can until the last moment..Medicine isnt really like any other kinda work ..its about doing all u can to save lives ...never quit until u gave all of u ..like u wrote there. So all i can say after havin read this post is that im proud of u just like i suppose many other ppl out there n the ppl who have writen u back around here ^^ ...Personally i hope to find a fullfillin job.. i study advertising n o well i find it too empty ...too empty ..tasteless ...anyway....ûr doing a great work over there ...u always need to risk things give as much as u can ..n if u didnt do it ..next time u surely can do it. Best of luck at work ^^
ahh really? so i could have been right after all lol thats some coincidence ...i really dont know why i thought u were an architect ..u had an architect face maybe? ..dont know ..My dads a doctor, during highschool i didnt have clear what i wanted to be in the future...n finally went into media stuff ..nway lately i have found out what i wanna do.... i know i wouldnt be a doctor like my dad would have liked me to be, cuz i know i have no the right skills to be one ..but i wanna do something for ppl who needs help in a bad moment ..i wanna be a paramedic or something related ...my minds always all upside down ..but of that im sure. So ull be kinda like my mentor ^^ lol .. i admire ur work , really.