Saturday, November 04, 2006

A medstudent, trying hard to decide his career path (yes, you have to decide on your specialty 2 years into medical school) asked me:
Why endocrinology? Don't you miss the adrenaline? The rush?

Flashback to my last Code Blue as a senior resident in the ICU:


"Code Blue, D-building, room 455"
That promptly wakes you up at the unholy hour of 315am. You'd be surprised at how much adrenaline your adrenals can churn out at short notice. You slip one your shoes and pop a piece of gum in to hide your breath. You race 300 meters to the site of action. Along the way, you half hope to hear a 2nd page: Code Blue, all clear (never happens, false alarm). Halfway, you start huffing. You pass the 2 pharmacists racing to the same place pushing the fabled 'crash cart'.
You see the room from 30 meters away. There is a crowd. Commotion. Need to get people up and free up space for those involved.
"MICU Senior's here!" You shout.
"Cards Senior's here", someone else shouts.
The main players of the code team are there; the team leader, airway and central line technicians. The crowd backs away to reveal the patient, straddled by a heavyset nurse performing chest compressions. You get a 20 second run-down of the patient's history, and do a quick look over. Defib pads go on. Airway goes in. You deftly thread in a central femoral line. Everyone stops momentarily to look at the cardiac monitor. Pulseless electrical activity. In goes the epi. The compressions and bagging resumes.
After 20 minutes of strenuous coding, we are about to give up. I have sweat running down my cheeks despite the thin, cool blue hospital scrubs. My back aches. Depending on the code team
leader, the time varies. This patient, admittedly we were trying longer, because this was totally unexpected. Her husband thought he'd be taking her to the nursing home in 2 days. Though unspoken, we dreaded the thought of a sweet old man coming expecting to discharge his wife, only to find her in the morgue. Just as we are to 'call the code' (stop efforts), her pulses return. We package her up and ship her to the medical ICU. Being the senior there, I accept the patient formally and begin a thorough examination on her. She's breathing on her own. But I find her pupils blown and dilated, unresponsive. Zero brainstem reflexes. Braindead. Given that, likely to stop spontaneous breathing soon
.
I had to break the news to her aged husband. And seek permission to stop the ventilator. But at least we've given family a chance to say goodbye.

No, I don't miss the adrenaline. No, I don't miss the rush. I like to take my time, to get to know the patient, to form a relationship, to even look forward to seeing them again for a 3-month follow-up. I like knowing them well enough to understand why someone would defer thyroid cancer treatment for a month because of his daughter's upcoming wedding. Or why she couldn't stop smiling ear to ear because she had lost 25 pounds. I like to have my time, for myself, for my wife, for my children.

5 Comments:

Blogger doc said...

sorry buddy,

unless you're in radiology or pathology, i'm afraid much of your life & time would be dictated by your patients. & rest assured, they wouldn't be giving you early notice (so that you can finish the nice dinner you wife lovingly conjured up for you, or kiss your kids goodnite) that they're going apnoeic.

welcome to the real world of code blues!

9:46 AM  
Blogger vagus said...

true but at least i get to sleep in my own bed.
and most endo practices here are group practices, so you take turns being 'homecall'.
actually radiology can be busy here too. many hospitals have inhouse staff 24/7, with interventional radiologists being oncall too.

9:51 AM  
Blogger Mei said...

I agree. I like that connection, that 'relationship' or bond that you form with the patient... not just "fixing them up" and "out you go".

And of course, a balanced lifestyle. Decisions, decisions... I just don't wanna miss seeing my children growing up (sounds clucky, I know).

10:25 AM  
Anonymous Anonymous said...

arghh... those were the days. But it was during your prime days that you can afford those adrenaline rush... and of course you take it as a challenge. an interest. and perhaps thrill... the kick that adventurous people used to search high and low.
Now wait till youre forty and see if you can take it any more. locally.. we say see if you can still "tahan" that sort of stressful nights. Not viagra I mean. Or may be you need that to pull you thru your twice a week family night duty.

I have seen those days and now it's easier and better off letting your junior taking over those "dirty" jobs... errr duty I mean, in the name of "training". Enjoy folks. Enjoy.

5:21 AM  
Blogger gnat said...

I can't help it... i couldn't resist: Oy, vagus, "wife" and "kids"... wooooo... this boy's got bitten by the love bug baaad.*tease tease tease*

11:18 PM  

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