Every so often I have experiences in the ED where I step back and say to myself, “Did that really just happen?”
A quick example is when a patient asked me to test his blood for the level of crack in it. He wanted a precise number so that he could sue his drug dealer. Yup. That's real. He thought his illegal drugs were not pure enough, so his plan was to take his drug dealer to court.
I told you that short story so I can tell you this one.
Working the night shift at our standalone ED means six busy hours followed by a gradual slowing into the night. Few people arrive after midnight, and the place dies after two in the morning.
I was sitting at my desk watching cat videos on YouTube. The entire building went black. Four seconds later, the power returned and the sounds of multiple computers resetting peppered the previously silent background.
“What just happened?” I asked the two nurses sitting a short distance away.
“Generator check. Once a month it resets to make sure it's working properly,” one said.
Ten minutes later, at 4:45 a.m., a patient arrived.
She had the ghastly appearance seen only in the critically ill. Her wide-eyed expression clearly conveyed her distress, and her gray skin cemented her condition. Her husband's face showed complete panic. The two nurses and I rushed into the room while registration quickly got her into the computer. The patient breathed rapidly while conveying her story.
“I woke up from a dead sleep fifteen minutes ago with crushing chest pain! It's tearing right into my back, and I can't breathe. I've never had anything like this ever,” the woman reported.
Despite being an isolated ED, we have the necessary technology to perform everything we need. Unless the generator just reset.
I quickly obtained the rest of her history and did a physical. For a 58-year-old, she was quite healthy. Well, she used to be. Her past medical history included only hypertension and diabetes, both well controlled. I called the CT tech.
“It sounds like a dissection. She needs to be scanned now,” I said to him. I considered all of the scary chest pain causes; she could have an MI, a PE, an aortic dissection, but regardless, I needed to find the cause. Now. With her being the only patient in the ED, I figured we could scan her immediately.
“CT is down,” he said.
“What! How? Why?” I said.
“It's down for an hour. The generator reset takes an hour,” he said.
I called EMS for transport. I lacked the diagnosis, but I knew I could not fix her here. The first ECG was handed to me. Normal, that's good. I checked on the patient again. Her husband paced the hallway outside her room while she panted and became grayer. Her pulse increased. We started an IV, gave an aspirin, some pain medications, and oxygen, and drew labs.
Light Bulb Moment
I called our ultrasound tech, and she wheeled over her large machine so we could scan the heart and surrounding vessels. They looked normal. Neither of us saw any dissection nor did we see any right heart strain that I thought might accompany a massive PE.
I called the main ED to tell my partner about my patient. Mid-conversation, my nurse told me that her cardiac monitor looked different and she was printing another ECG for me.
Thank God for ED nurses.
Roughly 10 minutes had passed since the last ECG. Tombstones. Massive ST-segment elevation. She actually was having a heart attack.
The lights flickered off and on again. The good news: The generator was done testing. The bad news was that this reset all the computers and instruments again.
I paged the interventional cardiologist to let him know a cath lab patient would soon be en route. The paramedics arrived. Then I heard what every EP hates to hear — my name shouted loudly by a trusted nurse.
“Brandt! Get in here now!” she shouted.
I ran back and saw my nurse leaning over the patient, feeling for a pulse. I checked, and then she started compressions.
I grabbed the crash cart. “We need the crash cart!” I said while wheeling over the cart. The other nurse looked at me wheeling the cart. She raised her eyebrows as if to say, “Good idea, genius, keep wheeling.”
We halted CPR and checked the monitor: ventricular fibrillation. Her terrified husband locked eyes with me for a split second as we heard the machine charge. SHOCK. Her body jolted. We continued CPR. After a minute, she started groaning.
Then, as if on “Baywatch,” the patient sat straight up, and groggily spoke, “Where am I? What's going on?”
EMS transferred her to their cot and transported her to the downtown hospital. Deep breath. The sudden quiet felt odd after the chaos that had just transpired. I looked at my two nurses with a did-that-just-happen expression. Deep breath.
Three weeks later, I received the nicest thank you card of my life from a woman who came as close to death as a person can before making a complete recovery. She received a cardiac cath and a stent, and recovered well.
So many things could have gone wrong, did go wrong, but despite it all, we managed to save a life. Everyone who works in the ED has plenty of stories where things went bad. But looking back, I find it's important to remember what is truly important.
I have had multiple shifts where I feel frustrated by admin, drug seekers, angry inebriates, or bad interactions with entitled patients. Remember why you chose this career. The Hollywood endings happen rarely, but treasure these experiences. You change lives. And sometimes, lives change you.Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.