Today was another fine day in Mid-Size Non Trauma Center's ED. Coffee in had, I stepped bravely into the department following a TERRIBLE night, waking up every hour with a recurring nightmare that I had overslept and gotten thrown out of clinical for tardiness. Auspicious start to the day, I must add.
Upon arrival my coffee and I were shoved into the doctor's dictation closet, because JHACO/TJC were expected to do an inspection of Stroke Center Procedures, and Coffee In Public Areas is not permitted when inspectors are present. Seriously, I think that medical and nursing professionals without ready access to coffee are a FAR bigger danger to their patients than coffee cups on the nurses stations. I mean, we're talking about alertness here, people!
Death's first victory was an elderly woman, past 80, who came in with mild stomach pain and more serious back and flank pain, presenting with an inability to get up off the couch. COPD? No. CHF? No. Diabetes? WRONG AGAIN!!!
AAA. Yes, an abdominal aortic aneurysm (never seen one before!) of 7cm, already popped. According to the (VERY excited) doc, she was currently stable because a clot had formed over the popped bit, rendering her sort-of hemodynamically stable-ish. No problem. We know JUST what to do with her- a quick-as-HELL trip up to the OR! Or...not. See, she was a Jehovah's Witness, and they cannot accept blood products, which obviously sort of limits the operating rooms that are willing to take a shot at an operation that ALREADY has a greater than 50% death rate. Half an hour of frantic phone calls later and one of the Large Impressive City Hospitals agreed to try a "bloodless" surgery on her. We managed to keep her alive out the door, and she actually survived the surgery, much to our surprise. Unfortunately, she suffocated 10 minutes later from a hemoglobin of .8- she literally had NO blood cells left, and was circulating saline. Even though I don't necessarily understand her beliefs, I have to admire how she and her family stuck to their beliefs in the face of death.
Death number 2 was much less exotic- a code that really had died at home, with paramedics working him on scene for HALF AN HOUR without ever getting a rhythm back. His family refused to let the paramedics pronounce him, and insisted on a hospital transport. I'm not really sure how that works, legally, but they were still coding him when he arrived, and were getting a VERY nice waveform on the monitor, complete with femoral pulses with compressions. On the other hand, his skin was mottled and grey-green. While part of me grieves for the family, and can understand that "letting" the paramedics call time of death would make it all "real", the rest of me wonders how they could have thought that he was anything other than dead. Live people don't look like this man did. I've seen living people, dead people, and dying people- even the woman with NO BLOOD LEFT, for all her pallor, still was unmistakably alive. This man was, just as unmistakably, quite dead.
I just hope that someday soon I will actually see a SUCCESSFUL code. Death, next time I'M cheating.