Saturday, March 12, 2011

"Who the Hell is Mr Henderson?"

The part of my job that I hate the most is being a responder to "codes" or cardiac arrests. I don't like emergencies, I don't like chaos and I don't like breaking ribs, all of which are unfortunate aspects of cardiac arrests. In a few short months, I will be a fellow instead of a resident and will no longer be a first responder to these sad events. Looking forward to that.

A few months ago, however, I had an experience during one of these codes that left me chuckling and I thought it was worth sharing with ya'll.

I was on call on general medicine on a slow Sunday, and my intern and I were trying to come up with activities to amuse ourselves as we awaited the inevitable onslaught of patients right around the time we want to go home. It always seems to work that way. We'll be bored all day, looking for work to do, then right around 5 pm a bunch of patients will arrive making it hard for us to be done at our goal time of 7 or 7:30. Both of our pagers went off at once which is always an ominous sign- it means an airway or a code.

On this particular instance, it was a code in one of the ICUs. I always feel a bit of relief when the code is in an ICU because at least the patient is already in an intensive care setting- the proper doctors, nursing staff and supplies are already there- as opposed to on a regular floor where folks aren't used to dealing with emergencies.

This particular patient, Mr. Johnson (obviously, not really his name) had a bad heart and had slipped into something called V-fib (or ventricular fibrillation) which means the large chambers (ventricles) of the heart were wobbling/fibrillating fast and ineffectually, not pumping blood out of the heart. Mr. Johnson was unconscious and for all practical purposes, dead. By the time I got there (<1 min), the ICU team had already responded, the patient had been "shocked" just once and he came right back to life. Phew!


However, Mr. Johnson (and his heart) was known to the ICU team and he was so tenuous that we worried he would slip back into V-fib at any second. So a small group of us hung around, brainstorming management strategies, hanging meds, making sure he had good IV access, etc. Mr. Johnson was flipping into "slow VT" which is not good but he had a good blood pressure and was awake and taking to us, and after a few minutes he would return to a normal heart rhythm. He was laying back in bed with his eyes closed (keep in mind that he's critically ill even when not in the midst of "coding"), so every time he got the in "bad" slow VT, we'd get him to talk to us or shake him a bit to make sure he'd wake up to make sure he was still conscious.

When Mr. Johnson once again popped into slow VT, this time for a long time, we were talking to him trying to wake him up and simultaneously getting ready to shock him out of it. One of my colleagues got right in his face and shouted "Mr. Henderson? Mr. Henderson? Can you wake up for us?" Mr. Johnson sat straight up in bed- way more animated than any of us had ever seen him- and said "WHO THE HELL IS MR. HENDERSON???"

Oops! I guess the best way to see if someone is awake is to offend them by calling them the wrong name! Lesson learned:)

(And for those of you who worry about these things, last I heard Mr. Johnson is doing just fine.)

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