Friday, January 26, 2007

Shorter Than Haiku

Two-by-four, face, jaw surgery.

Where did that tooth come from?

Patient self-decannulates tracheostomy, maintains saturations.

Hat tip to Disappearing John.

Even the average workdays are getting a bit off-center. There was a code down the hall. I was at the front desk when some of the specialty nurses were wheeling a patient back to their room after a procedure, and I heard one of them say "everybody's running."

I thought they were just joking that we had spotted them coming and were all running away from helping them settle the patient back in, but it was really that they had seen one of the hospitalists and some nurses rushing to a room. Then I heard somebody say "they're going to call it," so I started running too.

When I had seen which room they were going to, I knew it was going to be interesting because I'd seen that the patient was up in the cadillac chair. That's where they were when compressions were started. In the few minutes it took to get them back into bed another thirty or so people showed up. The usual routine. Compressions, shocks,intubation, drugs. The ventricular tachycardia went away, blood pressure last at 170/100 and pulse strong. Out the door and off to intensive care.

The monitor techs caught it originally. The patient had been seen by their doctor just minutes before coding. Then V-tach. We were guessing that since they had a chest tube maybe they'd thrown off a clot.

The patient with the jaw surgery was doing very well. The surgical technique used to repair it was neat and elegant, with an inch-long incision horizontal below the eye, and another incision within the oral cavity. Minimally invasive. Really beautiful work. They went home after a run of IV magnesium.

On a routine walkabout I noticed that one of my assigned patients had a tooth sitting on their bedside stand.

"Where did that come from?" I asked, and they said "I don't know. My mouth, I guess." They were going for surgery with general anaesthesia the next day so I made sure they didn't have other teeth that might bust loose during intubation.

On another walkabout I popped in on a slightly confused oldster only to see their trach cannula dangling uselessly out of its socket. It had been capped for days anyways and was probably due to be removed, but usually we do this for the patient ourselves. They had also pulled out their saline lock but there was very little blood from that.

That patient had pitched forward out of the caddy chair the day before when assigned to someone other than myself. They had a family member that liked to call us up to micromanage, over the phone, all the patient's care. Turning, changing, boots on, boots off, that kind of thing. I practiced a little passive-aggressive codependency by calling that person at their job just about every hour all day long to update them on things.

You wouldn't know it from reading this blog but I am actually very professional and personable while on the telephone, and the family member thanked me profusely for the calls. They even felt secure enough to stay home with their young children rather than visit the hospital with a list of demands and complaints.

That's nice.


GingerJar said...

I know what you mean. We coded a patient 4 times the other night. The family was irrate that we called to wake them up to come back to the hospital....they had made her a full code before going home. Guess that thought if she died we'd just keep her alive we are God's or something. They think NOBODY ever dies here.

Kookaloomoo said...

Why does nobody ever code in their bed? Why are they always in a chair, in the bathroom, etc..? I can count on one hand the number of recussitations I've done where the patient was tucked neatly in their bed. It's just soooo inconsiderate to expect the team to have to haul your lifeless body to the floor or bed, or to have to crowd into the bathroom to save your life. Hrmpf!