Conflicted with Authority: by Harbinger
Taken from my blog. Not edited or proof-read, and more of a rant, but I figured this forum needed some attention.
Perhaps it’s simply the fervor of youth, but I feel like some ER Physicians give up a bit too easily. As I’m on the code team, I see alot of things go down. Yesterday we had this woman bradied into respiratory failure and ventricular tachycardia while she was undergoing and endoscopy procedure. I knew she has a tension pneumothorax, but other than that no details. She was also a dwarf/midget, so I’m guessing she was just in a generally unhealthy disposition.
It was actually a rather small team as 4 of the 8 people were doctors. After we had worked her back towards a normal sinus rhythm, none of the particpating doctors could intubate her. Nobody could establish her airway at all, they just kept aspirating her stomach. Granted, she was a midget with odd anatomy (almost no neck) and she had a tension pneumothorax causing her treachea to arc, but seasoned ER Doctors should be able to intubate someone in their sleep. None of them could simply do it. None of them used cricoid pressure, and they even had a SCOPE, yet she couldn’t be intubated.
After 10 minutes without oxygen, they should have done an emergency Cricoidostomy, which they only mentioned after 30 minutes had passed. In the meantime, he kept saying how there was nothing they could really do for her. I asked why they simply didn’t use a pediatric combi-tube, and one of the nurses replied that they couldn’t because of her strange anatomy. This made absolutely no sense to me, but I could tell there was going to be no arguing. At that point I talked with the primary care provider (MD) about inducing hypothermia and using K+ channel blockers to reduce the oxygen demand while he tried to establish her airway. He liked the idea, and we implemented it.
So we’re slightly over half-an-hour into the code and still have no airway. Her heart occassionally slow to a stop and has to be brought back, but is easily done so with CPR. Despite the lack of oxygen, she’s giving one hell of a fight. I was so proud of her. Finally, when it came time to use the cricoidostomy as final resort, the ER MD said that it would be too difficult for him to do and that we’d need to call a trauma surgeon to perform it. That’s utter bullshit. I could have performed the “cric” but don’t have the scope to legally/medically do so. I was getting irritated inside during this code.
So 45 minutes later she’s having trouble keeping her heart going but she’s still kicking. The husband arrives on the scene and one of the doctors convinces him to let her go after he refused twice because even though she was alive, she’d probably be brain dead. The worst part was that the consent to cease was given right as the trauma MD walked into the room. I had to contain my irritation. Even though there was a probability of serious damage, she was being so resiliant that a near-full recovery could have been possible. At the very least, she could have been taken off life-support at a later date if that were so. To tell the truth, if he had just established an airway, she would have only needed supportive care. She should have fucking made it, but that ER doctor just reeked of a quiter to me. She was on the ropes, but still very much alive if you ask me.
I felt so awful leaving that code. Not simply because life was lost, or that I felt it was needlessly so, but her husband was a double-amputee (legs) and thus in a wheel-chair. Typically with disabled couples, eachother is all they have. Now this poor guy who probably has had a rough life as it is will forever be alone because the ER Doctor was a fucking quitter, the Endoscopist was incompitent, and the primary care was too timid to make any real decisions. I’m still amazed that he responded to my suggestion.
Way back when I took my first medical lisensure class (EMT-B), my instructor (a seasoned Paramedic) told us that the only way to move past losing patients is if you did everything within your power and ability to save them. I don’t think this was done, but with so many doctors around I wasn’t really in a position to say much. In the hospital, doctors are law–even when they quit. This is the third time I’ve seen doctors just not give a shit.
The prestige and title is nice, so is the reliable note-worthy income, but those are merely perks–not the reason you practice medicine. When I’m finally an ER MD, I am not going to quit anybody no matter who they are or why they are there. That is the job, and it’s what you do. At the very least I’ll then have the authority to tell anybody with a different opinnion about that to get the fuck out of my ER.
admin @ August 12, 2008