three great saves

 





Three great saves. Three true stories:

 

1.

 

It was a busy Saturday night in the hospital when I got the call from the neurosurgeon to say he was sending in an eleven-year-old boy. The child's mother had called to say that her son had fallen in his bedroom and by the time she got to him, his speech was slurred and he couldn't keep his balance.

 

"Meet them in the ER," he told me. "Let me know what you find. I'm on my way in."

 

When a neurosurgeon sends a child in to the ER, you expect the worse. A traumatic head injury. A seizure. A brain tumor. On my way to see the child, I ran through the differential in my mind.

 

I met the boy with his parents in a small examining room off the ER. He was awake but sleepy. I asked his parents what had happened and then I approached the child to examine him. It was then that I caught a whiff of alcohol. Assuming his parents had had a few drinks with dinner, I let it go. But when I leaned in to check the child's pupils and retina, it became obvious that the boy was the one who had been drinking. That would explain his slurred speech and imbalance. I called the neurosurgeon back and explained that the emergency was not an emergency at all. Not a head injury. Not a seizure or tumor, but an intoxicated eleven-year-old who did just fine with a little hydration and time.

 

"I am human

and I make mistakes."

~Cat Power~

 

2.

 

The patient, a 42 year old woman, had been admitted weeks earlier with subacute bacterial endocarditis. Her mitral valve was severely affected and she went into heart failure. Despite the active infection, the doctors had to replace her mitral valve. They had no choice. Then she developed an arrhythmia that required a pacemaker. A week later she had a stroke followed by a seizure that left her unresponsive. She was placed on artificial ventilation. After several weeks without a glimmer of improvement, it was time to make a decision about whether or not to continue life support. We called her family in. After a painful discussion about her poor response to treatment, mounting complications, and her poor prognosis, the family decided it was time to take her off life support.

I suggested that rather than simply unplugging the ventilator, shutting off the pacemaker, and pulling IV lines, we begin by tapering and discontinuing some of her many medications. First, we weaned her off the anti-seizure meds. Then we started cutting back on narcotics and sedatives. To our amazement, she opened her eyes. She started to follow simple instructions. Within a couple of weeks she began to speak. We were forced to concede that she had been sedated by the drugs she was on to permit artificial ventilation and to suppress her seizures. Her stroke left her with a minor motor deficit, but...long story short...she eventually left the hospital and returned home to her family.

 

"Mistakes are the portals

of discovery."

~James Joyce~



 

 3.

 

The patient was admitted directly from the ER in the middle of the night with a diagnosis of acute appendicitis having presented with a 12 hour history of right lower quadrant abdominal pain. As the intern on call that night, it was my job to perform the admission history and physical, and to write orders before the surgeon could begin the operation. The patient was already in the operating room and he was ready to go. "Don't waste time," I was told.

 

So I took a quick history, checked her vital signs, and listened to her heart and lungs. Then I examined her abdomen.  She was tender deep in the right lower quadrant directly over McBurney's point--a classic finding in appendicitis--except for one thing. When I pushed in, something throbbed against my fingertips. It was painful for her as expected, but I caught my breath when I felt the pulsating mass and heard the whoosh, whoosh, whoosh of blood coursing through it. I'd seen several cases of appendicitis by that time, and trust me, the appendix does not pulsate. But a dissecting aortic aneurysm does. This was a problem. The OR wasn't prepped for this kind of procedure. The blood bank would need to be alerted, the vascular team assembled, and ICU notified. And time was critical.

Just then the chief surgeon backed through the OR doors and the nurse slipped the gloves over his hands. "Are you just about finished, doctor? We need to get started here."

As an inexperienced intern, I ventured apologetically, "I, uh--I'm not sure about this but, uh--would you mind just checking her abdomen with me? Something doesn't feel right."

The surgeon rolled his eyes and snapped off his gloves even though he would have to scrub all over again and that would take time. He placed his hands grudgingly on the patient's belly, and pushed harder than he needed to, in my opinion.

"Damn," he hissed. "Page X-ray, stat. Get the bypass team in. Alert the blood bank."

That night, I got to assist at my first AAA repair.
 

"Mistakes are the usual bridge

between inexperience and wisdom.

~Phyllis Theroux~

 



If you are a health care provider--a doctor or nurse, a first responder or a therapist of any kind--you may have made some mistakes in your career. A missed diagnosis. A botched procedure. An oversight or misperception. You may also have made a few great saves in your lifetime. Maybe you led a successful resuscitation. Perhaps you're the one they called on when no one else could get the IV started. Maybe you picked up the heart murmur everyone else missed. Perhaps something you said or did prevented someone from taking his own life. If we are willing to learn from the mistakes we make, the great saves will come.

 

"Individually we are one drop,

but together, we are an ocean."

~Ryunosuke Saloro~

 

jan



PS: Kindly disregard the funky formatting on this post. I am clueless...