Monday, November 23, 2009

The One That Got Away

This one was from several years ago, and I may have mentioned it already in a post, but it invaded my dreams last night, so what better dream therapy than to bore you all with it.

I was an ER tech at the time, so I don't know all of the details, (as an aside, it is interesting to see life from both sides of the ER bubble.  I thought that I was so involved in patient care as a tech, and now that I am an RN, I realize that I really didn't know anything about what truly goes on in the ER.  I'm sure it would be a similar jump to go from nurse to doctor.) but I remember this guy was a really nice guy.  He was probably about 50 years old with a great sense of humor and he and his brother were joking back and forth every time I went in the room to do anything.  He had come in for sudden onset of debilitating leg pain.

A few hours later, I was working in another area of the ER, so a different tech was to take him down to radiology for an imaging study.  Somehow along the way, he coded and was rushed back to the ER.  One code was already in progress (I was tied up in that one - another devastating and unexpected code), but whoever was free went to help save this guy.  In all, they tried for an hour and a half but had to call the code.

As I think back on it, I have to think that the most logical explanation for this guy's code was a PE, but that seems too simple and I had the impression that the nurses and docs were confused and had no explanation.  And the poor brother was devastated.  One minute he goes in to the ER with his brother to get some pain pills for a leg injury, and the next minute, he is signing the mortician's paperwork.  And as if he needed the case compounded, nobody on staff was assigned to be with him and explain what was happening, so he stood outside the door to the room watching CPR go on and on and on, not knowing what to expect or how to take what he saw.

As you will hear from anybody who has been involved in codes, they are very stressful for the team working to save someone's life, and often, in some kind of attempt to maintain sanity, and cope with the situation, a few jokes will get cracked.  Such was the case here, and because nobody ws with the brother and he couldn't hear what was happening, he just assumed that nobody cared about his brother and perhaps even that they were making fun of him.

All in all, it was a very sad night and a hard one for the entire staff.  By the time all was said and done, three codes had been run simultaneously, with the only survivor being the 88 year old with dementia and a laundry list of health problems, while the two younger, generally healthy patients both getting the wrong kind of discharge.  What I will always take away from that night, however, was the vision of the brother of the patient I described and the 16 year old daughter of the other patient, both of whom were standing outside the door in shock, trying to find a way to cope with what they were seeing.  I did what I could to try to comfort the daughter and explain what was happening, but I was young and new at this and didn't know what to do.

When they teach you the ABCDEFGHI mnemonic in your TNCC and ENPC classes, please don't gloss over the F is for Family part.


Epijunky said...

Absolutely, yes.

I know it's not always possible, particularly when everything's blowing up in the ER, but.. This is the last memory of their loved one that they're going to have.

A horrible situation.

StorytellERdoc said...

Great post today. Really enjoyed your writing and the reality of codes. See a lot of that with my job as well.

Just started my own site and checking out other medical blogs.

I will be following.