Pumps

He was a beautiful elderly man and his family members were gracious and courteous. An army surgeon who had married one of his combat nurses back in the days of real television news on just four over-the-airwaves channels, crappy Doors singles dominating A.M. radio, and the Vietnam War.

He was lucid and his stories about how he met and fell in love with her and his improvisatory surgical techniques had me staying in his room to listen. My other patients were not so needful of me anyways. Lucky that.

The drab-green canvas gurney burst through the doors with the proverbial sucking chest wound. No tubing to be found in the shaky little field operating room, so somebody fetched some from the garage and they "sterilized" it in a jar of rubbing alcohol while the surgeon used a Kelly clamp to punch a hole in the soldier's flank.

"It was a gusher," he said, like I couldn't have guessed. Morphine for the soldier.

They inserted the tube and used a rubber band to tie a condom to the end of it, which they slit to create a makeshift Heimlich flutter valve.

I had worked with other surgeons who had similar experiences from that era. One could insert a chest tube at the hospital bedside in two minutes flat and it was stitched into place before the patient realized he'd even started.

The elderly surgeon had metastasized lung cancer spread to the bone and liver, and he was generally in enormous pain. Our hospital has a nurse practitioner who specializes in pain management so she got on board and we phoned the primary doctor and begged him for a morphine pump.

He was a little reluctant, but the patient and family said they "wanted to try it."

The patient was laboring to breathe even with a 100% non-rebreather mask, and anything we could do to make him less uncomfortable would be welcome to him.

The primary doctor gave us an order to initiate a morphine pump at 0.5 mgs. an hour and titrate it up to 2 mgs. per hour as needed. I told the pain nurse about the order and we looked at each other and said, overlapping one another's words, "let's start it at two."

I had an hour or two before my shift was over. Soon after we set up the automatic pump he was visibly relieved. His respirations stayed steady but less labored. Morphine's a great dilator. He was able to talk without distress.

His wife and daughter thanked and praised us repeatedly for this simple intervention.

I went home and walked the dog. When I came back the next day the news was that he had died later in the night shortly after his family had said good-bye to return to their hotel.

This is totally different from the recent stories regarding possible euthenasia
in a Katrina-flooded New Orleans hospital. I had a pump. I had electricity. I had help.

New Orleans had no electricity, no supply lines, no help on the way in and no way to get out. The hospital was flooded.

So you can plainly see that my actions were entirely within the bounds of human propriety and clearly criminal charges do not apply.


More here and here.