Monday, January 07, 2008

68

I wonder what it's like to wake up on a normal, beautiful, sunny and crisp winter day, go to a restaurant with friends for a bit of lunch, step outside, trip on a grating on the street, then fall into a coma and die?

As a paramedic student, I've been spending an awful long time in the Emergency Room lately. Mostly I'm there to help out -- you know, start IVs, do EKGs, take vital signs, etc., but also to observe. Thus I find myself observing a late-afternoon scamper as a notification from an ambulance comes in for a person falling from standing height, unconscious, being manually ventilated.

Doctors are literally pouring out of the woodwork. "Notify the trauma team!" screeches one MD, "Call neurosurgery!" yells another, "Does respiratory know?" asks a third. These people haven't even seen the patient yet, but already beepers and pagers are going off all over that block in Greenwich Village.

Finally, red and yellow flickering lights can be seen through the opaque doors of the ER as we all watch from the trauma room down the hall. Thirty seconds passes, then a minute. A doctor starts to walk towards the entrance, when... swoosh!... it slides open. Two medics are calmly and carefully pulling their stretcher towards the sea of green scrubs. The one at the head gently squeezing the bag at the patient's head every few seconds. They wheel him into the room and transfer this man onto on the hospital bed. A whirl of activity ensues.

Clothes are cut off. The medics are grilled by one doctor. Another nurse starts an IV and draws blood. Another doctor makes the decision to RSI (Rapid Sequence Intubation) the patient, a portable X-ray machine is suddenly in view. One doctor gets a brainwave: "This doesn't look like a trauma! There's no sign of external injury! Someone call the stroke team!" Ten doctors all working on one patient. Some independently of the others. How they know what another is doing, I don't know. Maybe they don't....

The decision is made to transfer the patient off the longboard and take off the collar protecting his cervical spine. I've moved outside the trauma room to talk to one of the medics who brought this unfortunate soul in. He asks me, "What do you think?" I shrug. The he asks me the question that's really bugging him: "Do you know why they're taking him off the board?" Again, I shrug -- they don't think it's a trauma I tell him; but I agree with him, if this were my patient I would leave him on the backboard. Both of us are powerless to stop the mass of doctors.

The process has finally reached an end. The patient is carted out for a CT of his head and any other body area they can think to irradiate. The show is over.

About an hour later I notice that the patient has returned. He's now in the main treating area, lying in bed, next to another patient, looking just like the rest of them, only this patient is on a ventilator. I ask the attending physician if I could look at his imaging. The CT isn't good. I massive bleed on the left side of his brain with midline shifting. On of the ventricles on the right side is empty. Essentially his whole brain is being squeesed through the only place where it can go: down through the hole which the spinal cord passes. I start to form a question, but the attending already knows what I'm going to ask.

"This was probably caused by his fall," he says, "There's nothing we can do. It's only a matter of time."

68 years old on a beautiful, sunny, crisp winter day.

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