Tuesday, March 31, 2009

Just Another Night

Someone's coding in the ICU.

The patient's been coding off and on all day.

I strongly believe that in most situations we should get to know our patients as best we can. Faces. Names. Fears. Hopes.

On occasions like these, though, we often can't know. We show up because a disembodied voice over the loudspeaker announces the code or calls for "rapid response team, stat." We've never seen the patient before. We don't know his or her name.

Nor, I would argue, should we be expected to take the same approach we would for other clinical care situations. A code is not the time or place to be holistic. A code is about numbers and lists. Blood pressure is 50 over 30. Heart rate dropping to 20, 10, zero. Patient with a history of cardiac disease, asthma, and gangrene or sepsis or bowel obstruction or trauma. The patient does become, for a tense, crucial moment, an amalgam of data points.

And we NEED those data. I would argue that people like me - who do feel pain when others suffer, and cry over individuals and their stories, and long to hold people's hands and offer comfort - need those numbers to occupy center stage during a code and obscure for a moment the identity of the dying person, so we can concentrate on the resuscitation. Names, faces, memories, personal connections - these can be a dangerous distraction.

I watch the monitors while the chest compressions are being performed and the epi and atropine are being injected. I am looking for those numbers to change, willing them to go higher. They are our guide and our visible goal. When someone is dying in front of our eyes, the hard realities of math and science keep us grounded and focused; they're both the bad news and the ally.

A code is the only time I allow myself such calculated distance when taking care of patients. I need that mental space. It's important.

After the code team gets the patient back, the other elements of taking care of the patient return in a rush of feeling. Relief. Concern. Sympathy. Even fear, after the fact.

Walking toward the call room I see the walls of the main entrance from a large window in the corridor, feel the weight of the hospital around me. Outside, traffic is slow; the town is winding down. What must we look like to passersby? Just a pile of bricks and stone, housing the sick? But in here lives are changing. In one window there might be a nurse pounding on someone's chest, trying to defy death. In another, a mother weeping tears of joy over a baby just minutes old. In yet another, an anesthesiologist looking out at the world, missing her family, and thinking of a patient who's hanging on to life by a thread. An ordinary night at the hospital, in other words; just another night.


Kirti said...

Wow, great story!

Megan said...

Thank you for posting this, T. I really admire you for your ability to recognize when you need to be detached from your patients and when you need to connect with them, and to be able to make that transition.

I think many doctors find this a difficult skill to master--how to care when you need to care and be detached and purely clinical when you need to be detached. They deal with this dilemma by being detached all of the time, which may make them efficient in emergencies, but not so great at seeing their patients as people.

It is great that you have this ability and I hope you can share this skill with others in your profession.