Thursday, September 09, 2004

I saved somebody's life yesterday

Well, I helped, at least.

I sucked a mucus plug out of a patient's trache, no big deal. But it's left me unexpectedly shaky and flipped out.

Here's the deal: I had a patient of a sort I'm not used to: a radical neck dissection for laryngeal cancer, with a tracheotomy that was fresh. Frech traches are nasty, since your body produces lots of mucus to try to deal with the insult of having a hole cut in your airway, plus you have lots of swelling. Those issues combined with the fact that the trache tube can come out make a fresh post-neck-dissection patient a bit of a worry all around. I was paranoid-ly checking on her every fifteen minutes all morning.

The patient's daughter came out of the room at 0918 and said, "Jo?" in that tone of voice that means "I hope whatever's happening isn't really happening." I flew into the room to find my patient panicking and unable to breathe--no breath sounds in the chest, no air movement through the tube. So I called Dave, our charge nurse, and he brought in an ambu-bag. (Ambu-bags are those squeezy things that pump air into your lungs when you're on "E.R." on a gurney being rushed down the hallway by Noah Wyle.)

Her oxygen saturation had gotten to 25% by the time Dave and I managed to knock that plug loose, me with suction and him with the bagging. 80% is considered a critical level.

At 25%, a person goes limp. Her mouth falls open, her eyes dilate, and she doesn't respond. Her heart kind of flutters around in her chest, unable to keep beating without the stimulus of the lungs.

Then, when you finally knock that damned plug loose with the bag and the suction, her breath rushes back into her throat with a huge rattling sound and she starts to grimace. That's when you come back into your body and realize dimly that everything you've done for the last two-and-a-half minutes has been totally automatic, without thought, without conscious action. You realize that you've ordered a crash cart and that it's appeared from somewhere without your noticing, that Daughter and Son-In-Law are looking a bit tense, and that you're shaking.

Then you look at the clock and see that it's 0922. It feels like 1630.

Like I said, a mucus plug is officially no big deal. They happen a lot, so you're prepared for them: the fresh trache is near the nurses' station, right across from the cabinet where the respiratory team keeps its supplies. I didn't have to call a code (thank you, God, thank you), and my patient came back fine and dandy, if a little tired.

It affected me much more badly. When her O2 sats dropped to 25, I thought "Fuck." That was all. Just "fuck." Not "Fuck, now I'll have to code her" or "Fuck, now she's dead" or "Fuck, her pupils aren't reacting" just "Fuck." With everything else rolled into it.

Dave looked at me afterwards and said, "Good job." From him, that's high praise.

I went and got mashed potatoes and green bean casserole and buttered carrots for lunch.

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