By Cyndi V
Reaching for my hand, my patient looked at me desperately. She was working mightily to catch her breath, her eyes wide with fear, her short blonde hair plastered to her forehead with sweat. Her heart rate raced away on the monitor, climbing 196–205–222, with anything above 120 becoming concerning to us ER folks.
There wasn’t a lot of time before her heart would get fatigued and she would lose consciousness. Working quickly, the three of us already in the room, veteran ER nurses, did everything we knew to do in this case. The medication to reset her heart hadn’t worked. She was working too hard, and we knew the only option was going to be to shock her.
Our ER doc and the resident had left the room to check on someone next door as we set up. We had our patient on high-flow oxygen, the sticky pads that would deliver electricity placed on her chest and left side. We called out to the doctor, who came back in and said confidently for the benefit of his resident, “We ready to go?”
We were always ready.
I was standing between the crash cart and the patient, ready to deliver the shock whenever the doc gave the go-ahead. It was set to the Sync mode, which we were well aware was the ONLY mode you use on a living, breathing patient with a heartbeat. The doctor put his hands on my shoulders and physically moved me aside, asking the patient, “Are you ready? It will be over soon, I promise.” He reassuringly rested his hand her shoulder. She nodded, tired, desperate and short of breath.
Then he did something that made us all yell out at him.
He switched the mode on the defibrillator to unsynchronized.
“Ok, let’s do this,” he said with an air of “I’ve got this, watch me look like God to this unseasoned little resident here.”
“No! No, doc, we have to have it in sync mode!” I boldly argued, sweating because I was confronting a long-time ER doc while knowing this patient’s life was potentially at stake.
The other two ER nurses in the room concurred, one going over to the defibrillator and immediately switching it back. The doctor’s face turned sullen, and his eyes were pointedly angry, as though we’d all just committed a mortal sin. Saying nothing, he switched the mode back to Unsynchronized and told the patient to hold on.
I took her hand and squeezed it tight, releasing just in time for the delivery of the shock. The patient did the characteristic back-arching jump that occurs when the electricity surges through the body, then fell back limply. We all immediately looked to the monitor, which now showed asystole, a.k.a., she had flatlined.
Now we had a new problem. This patient had just been shocked into eternal rest. Desperately placing my hands on her chest, we began “coding” her, doing chest compressions, delivering medications, trying — trying — trying to bring this lady back.
Eventually, our efforts were successful. She came back to a heart surging with life, a normal heart rhythm and tears of joy that she had survived. She had no idea what had taken place. This doctor, without so much as a word, peeled off his gloves, dropped them in the trash and walked out. No, “I’m so sorry, nurses, I should have listened to you.”
He was a know-it-all, and he’d nearly killed someone because of it. I would never trust him as a physician again. Once your ER nurse has lost faith, your job will never go smoothly again.
We make sure of that.
Conversely, one afternoon we got the ambulance dispatch that there was a woman seven months pregnant being transported who was severely short of breath. We prepared the trauma room in the case that things got ugly. Two minutes later, when they wheeled her in on the stretcher, there was already a paramedic straddling her gravid belly and pressing desperately on her chest. The woman was a dusky gray color. We were not equipped at our rural hospital for NICU babies or obstetric emergencies.
There was just us, the ER, who deals in mom and babies when we absolutely have to, but we don’t like to because it’s terrifying. Our ER doctor that day was a tiny, dark-haired, kind and incredibly intelligent woman whom we would all trust our lives with. She commanded the room, and we all did exactly as she said. I had worked enough trauma with her to know this woman knows her stuff.
As they wheeled the patient into the trauma bay, and we took over with chest compressions and hooking her to monitors and the defibrillator, starting dual IV’s and fearing that we were about to simultaneously lose two patients, she yelled to us, “Get me a stepstool, a scalpel and a bottle of betadine.”
We immediately supplied what she needed, as paramedics resumed the role of CPR. I continued working on starting another IV while watching our doctor put on a sterile gown and gloves, a splash mask and paper booties. She was handed the scalpel and instructed another nurse, “Pour it all over her abdomen.”
A moment later, she was delicately but demonstratively cutting through the layers of flesh and muscle, right down to the shiny red uterus. With one final swipe, fluid and blood sweeping out of the patient, down the bed and falling in sheets to the floor, the physician dropped her scalpel, pulled the tissue apart with her hands, and pulled out a shriveled and blue-tinged baby boy.
At once, the OB nurses went to work and moved him to an incubator to resuscitate him. Our doctor then began the tedious task of stopping the mother’s bleeding and putting her back together while at the same time, instructing us on the meds she wanted to be given to the patient and stepping back when we yelled out to the room that we were preparing to shock the patient.
Moments went by, seeming to last forever as both mother and baby were the focus of the chaos and crowded room. We tried, desperately, to bring Mom back. We took over 45 minutes shocking and compressing and gave medications while our doctor put her back together. We tried everything, but it was to no avail.
As the moment came that our doctor instructed us to “call it” and stop lifesaving measures, we reached over to turn off the defibrillator in defeat, tears stinging our eyes. At that moment, the eerie, respectful silence of a life lost was cut with the tiny, vocal protests of a new little human being, warm, pink and breathing, over in the corner.
As one life was lost, another began, in the same moment. Though baby would have to be transported to a NICU via helicopter, he was stable enough to be brought out to his Daddy. As Daddy took his son in his arms, handed to him by an OB nurse, he was told that Mom had not made it, but the doctor had saved his little boy. I can’t imagine the conflicting emotions that surged through him at that moment, and he had a long road ahead.
But if not for our fearless, intelligent attending physician, Dad would have lost them both. Not only did she save that little boy that day, but she saved us, knowing that some glimmer of good had come out of a tragic and terrifying day at work.
Which physician can you identify with? In these cases, the difference between intelligence and a know-it-all mentality was a life and death matter. Granted, most of us don’t have those decisions to make on a regular basis, but our behaviors can determine another person’s perception of us. How can you tell a know-it-all from someone brimming with intelligence?
Read the original article here.