Farmer 'N The Dell

Television is great for making doctors heroes. Despite personal weaknesses, the physicians of Gray’s Anatomy, House, and ER manage to save patients from health disaster, demonstrating clinical brilliance and extraordinary skill. But life as a doctor isn’t really like television, and in spite of remarkable advances in medicine, we can’t save patients all of the time.  This was made abundantly clear to me the other night.

I was carrying the ”float” beeper, which just means that I was the anesthesiologist charged with managing the OR that night. When the pager went off, I was standing by in one of the ORs while a nurse anesthetist woke a very sick man from anesthesia. The pager readout was worrisome: code blue in the pediatric intensive care unit. “I’ve gotta go,” I told the nurse anesthetist, ”I’ll find someone else to standby in my place.”

But I didn’t really know who was available. I was moving fast, grabbing the anesthesia “crash” box out of the workroom and heading to the Pedi ICU. I called the one person I knew who had a spectralink phone like me, got her to go help the nurse anesthetist, and then barged through the door of the ICU.

You can always tell where the code blue is by the crowd of people standing around. There is a general sense of chaos, as quick diagnoses are being made  and management plans are formulated. But this wasn’t an ordinary code blue. This was a teenage girl, and her face and body were so bloodied that she looked like the victim in a horror movie. Bright red blood stained her gown, the bed, and even the anesthesiologist who had beaten me to the scene and was trying desperately to put a breathing tube in. One of the pediatric residents pumped on her chest, kneeling on the bed beside her.

This, I knew instantly, was very bad. “What happened?” I asked one of the crowd of doctors. “Fungal pneumonia, started bleeding out of her mouth twenty minutes ago,”  he answered as took his turn performing CPR.

From the head of the bed, my colleague reported grimly that he couldn’t see anything as he tried to reposition the lighted laryngoscope in the girl’s mouth. I called for suction, knowing that as long as the girl’s mouth was filled with blood, my colleague would never be able to see where to put the breathing tube. And of course, there was so much blood that the first suction unit went down and we were forced to set up a second. Meanwhile precious seconds ticked away, and beneath the red of her blood I could see the ghastly blue of her skin.

Everyone was shouting, trying to make their voices heard above the din. A sense of desperation filled the room as first the pediatric surgeon, then the cardiac surgeons, and finally the vascular surgeons showed up. My colleague managed to get the breathing tube in, but blood welled up in the tubing making ventilation a futile effort. It seemed impossible that a person could bleed so much.

It was obvious that we couldn’t stop the bleeding in the pediatric ICU, so we raced her down to the cardiac OR, a resident kneeling at her side performing CPR as we rolled her down the hallway. I’m glad I didn’t see that. It would have scared any bystander to death to see that bloodied girl with the doctor pounding on her chest.

The girl died on the table. The surgeons opened her chest only to find that the girl’s pneumonia had invaded her pulmonary artery, one of the main vessels exiting the heart. Her heart chambers were empty. She had bled to death before our eyes.

We see death in the hospital. It’s part of being a doctor. But there is something particularly awful about a child’s death, and particularly one so rapid and grisly. It cast a pall over the OR that lasted through the night. In the morning, one of the nurses asked me if it had been swine flu. Surprised, I answered no. It was fungal pneumonia.

But I was wrong. The girl had come in with swine flu, I learned later, and developed the fungal pneumonia as a complication. In the fury to save the girl, none of us had worn proper protective gear.

Now we wait out the incubation period again.

This entry was posted on Monday, October 26th, 2009 at 4:51 pm and is filed under Swine Flu, Tales from the Trenches. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.