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.

As I mentioned in my last post, the head of the National Institute of Allergies and Infectious Disease says the swine flu shot is as safe as any flu shot becaue it’s made the same way with the same manufacturers. That may be true, but what people ought to know is that many of the flu shots available contain the mercury-containing preservative Thimerosal.

What’s the big deal, you ask? Mercury is a known neurotoxin, and there are some strong believers that Thimerosal in vaccines is linked to the rising rates of autism in our country. This theory has been discredited by the Institute of Medicine, a not for profit, non-governmental organization associated with the United States National Academy of Science, which was tasked with investigating any possible link.

That being said, as a precautionary move, our government phased out Thimerosal as a preservative in children’s vaccines back in 2001. Influenza vaccine is one of a handful of exceptions. Flu shots in multidose vials contain Thimerosal. Single dose flu shot vials and the nasal vaccine do not.

So what should you do? I’ll probably have my kids get the nasal vaccine. It doesn’t contain Thimerosal, and it doesn’t involve a poke with a needle. Now, this isn’t recommended for asthmatics or anyone with a compromised immune system since the nasal vaccine contains live attenuated virus. Other people who should steer clear of the nasal vaccine include pregnant women and people with heart disease or diabetes.

And myself? I’ll take the regular shot, with or without thimerosal. The amount of mercury in the flu vaccine is about 25 micrograms. To compare, a tuna fish sandwich contains about 28 micrograms of the heavy metal. I’m not worried about eating a tuna fish sandwich. Why should I worry about a shot? On the other hand, as a health care provider, I do worry about swine flu. I’m exposed to it at work and out in the community. The benefits of a flu shot clearly outweigh the risks in my eyes.

If you find yourself troubled about mercury and are ineligible for the nasal vaccine, you can request a flu shot from a single-dose vial (which doesn’t contain Thimerosal). These shots are in limited supply, so you may be forced to wait to get vaccinated, but Thimersosal-free shots are out there. Contact your primary care physician for further details.

If you’re a pregnant woman, DEFINITELY get vaccinated. For some reason, H1N1 is particularly nasty in pregnant women. These women have six times the risk of dying from swine flu as compared with the general population. Tragically I have seen such a case in my own practice. A previously healthy pregnant woman contracted H1N1 and died a drawn out and ugly death. This is a no-brainer. If you’re pregnant, get vaccinated.

Get your child vaccinated if he or she has underlying health conditions. This year’s swine flu is a young person’s disease, disproportionately affecting people under 40. Children are excellent germ-spreaders and hang out in groups– the ideal set-up for flu transmission.  A note of caution, however. The only available vaccine currently is the nasal spray variety. If your child has asthma, skip the nasal spray, as there is some risk that it could trigger an asthma attack. Wait for the “shot” form of the vaccine, which should be available later this month.

Older people with underlying health conditions should also get vaccinated. Interestingly, people born before 1957 have some immunity to H1N1. That’s because H1N1 circulated before 1957. Oddly, the H1N1 version of flu disappeared for 20 years after 1957, leaving a huge window of people with no previous exposure to the disease and thus no protective antibodies. That being said, this H1N1 is still different from earlier H1N1. Previous exposure (especially if it was sixty years ago) doesn’t guarantee full immunity. If you’re vulnerable, and people with underlying health conditions such as lung and heart disease are vulnerable, get the swine flu shot.

Lastly, a word about vaccine safety. I must admit that I feel some qualms about vaccinating my children with a new and rushed-to-service vaccine, but Dr. Anthony Fauci, the director of the National Institute of Allergies and Infectious Disease, says, “The H1N1 pandemic flu vaccine is made exactly the same way by the same manufacturers with the same processing, the same materials, as we make seasonal flu vaccine, which has an extraordinarily good safety record.” That’s encouraging. The WHO is reporting that vaccine trials in China, in which 39,000 people were vaccinated, are very reassuring. Only four recipients reported side effects such as muscle cramps and headache.

I’m getting my flu shot next week. I’ll let you know how it goes.

The Infamous PAPR

You may be wondering what a picture like this is doing in a healthy lifestyles blog, but if you read my earlier post “Tales From the Trenches,” you know that health is often as much a consequence of luck as it is of good behavior and genetic good fortune. And let me tell you, I feel lucky!

 Swine Flu is sweeping through the nation, and as an anesthesiologist I see the sickest of the sick– the patients who get the flu so bad that they wind up on a ventilator and often die. What’s most appalling is the age of our patients. These patients are young, in their 30s and 40s, and sometimes they have nothing wrong with them except the flu. But it’s enough.  These people are terribly sick.