I read Dr. Michael Tetwiler's article and was reminded of a case I had that thoroughly exhausted me and on which I was sure I had failed but later received a big thank you. (EMN. 2022;14:3; https://bit.ly/3Z1mFPj.)
A 40-something man came in with persistent V-tach after being shocked three times by EMS. He was from Indiana and taking his wife and kids to a large amusement park in our area. His wife was driving when he started having chest pain and shortness of breath. By the time, they arrived at the park, he was in extremis, and EMS was called. I ended up shocking him 16 times (also used anterior/posterior before it was in vogue).
He received lidocaine, procainamide, and even Bretylium (first drug given to E.T.). I called for a cardiologist, and he wanted to know why he was called when the patient was in sinus rhythm. I was drenched in sweat and spent.
The patient left on a ventilator with decorticate posturing. One of the nurses said he was brain dead. A week later, I was stopped in the hall by this patient, and he thanked me for saving his life. He had no memory of me, but the nurses told him that I saved his life.
Always remember, when it is darkest, you can carry the light.
Jonathan Van Zile, MD