Letters from the Pit by Dr. Patrick Crocker

Author:Dr. Patrick Crocker
Language: eng
Format: epub
Publisher: BookBaby
Published: 2018-12-06T17:49:53+00:00

I MEET A GHOUL

Dear Jack,

I was working in the Children’s ER last week and had a remarkable case I want to tell you about. Let me set the scene:

It’s morning, and we get a phone call from hospital security. A man in the parking lot called that office to say he had sudden chest pain. He was parked somewhere near the entrance, he had told them. And then the phone line went dead. The staff, pushing a gurney, run out of the ER and down the hall toward the entrance to try and find him. We get a lot of calls to respond to someone who has fallen or fainted in the hospital, and it usually turns out to be a big nothing. So, I continue working without another thought about the drama that’s heading my way. Hearing that the line went dead was a little worrisome, but cellphones often drop calls.

Several minutes later, security calls back. The man has been found, staff is on their way back, CPR in progress. I immediately think, fat chance of saving this one, but it will be a good drill for the pediatric ER staff. We occasionally get adults here. A visitor having chest pain or an actual heart attack. My team needs the experience. This one, though, is probably going to end as just a practice run, training for someone we might actually be able to save in the future. Most people don’t come back from a cardiac arrest, even in the hospital.

We assemble in the room, and in the brief moments we have been waiting, my mind wanders back to my first emergency medicine specialty book, given to me as a wedding present by my wife, Marcia. I cherished that book and still have it, probably tucked away in a box. The first chapter was titled “The Mechanisms of Dying,” or some such. It is one of the most brilliant inclusions in a book I have ever encountered. The insight of the author was exceptional: If you understand how a person dies, the path for saving the person has been shown. It seems simple: Reverse the mechanisms of dying and save the patient. I often think every ER resident should read this chapter. Sadly, this book has drifted into obscurity, replaced by other more recent texts.

My thoughts vanish as the staff fly through the doors, rolling at breakneck speed down the hall, one person riding the gurney doing CPR. Good CPR, too, I think. Deep chest compressions. Someone paid attention during cardiac lifesaver class. I am thankful I have a good staff made up of good people. As they roll into the room though I have a sinking feeling. This is probably the bluest patient I have ever seen. We call this cyanosis, when the skin turns blue from a lack of oxygenated blood. A color picture of this guy should be in a book, with the simple caption, CYANOSIS.

As the nurses are attaching the defibrillator I listen for breath sounds. He is getting good ventilation with the Ambu bag.

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