Saturday, November 27, 2010


Two transporters, black.
One pregnant white nurse, Serena, and me.
And one enormous Patient. It's going to take all four of us to move him to his new digs.

While we're all waiting to figure out what room Patient's supposed to be transported to, we're watching his TV. A Johnsonville sausage commercial plays; the only black man in the commercial enthusiastically accepts the offer of a sausage fresh from the grill, asking his white host, "Do I look like a chicken man to you?"

Transporter 1: "Why, yes, as a matter of fact, you do."
Transporter 2: [snickers]
Serena: "Mmmmm, chicken...that sounds so good!" [pats belly, leaves to pee]
Me: [looks at Patient, prays silently he's not listening to us]
Patient: [who happens to be black; looks at me, smiles. Fuck.]

Ah, diversity. Don't underestimate its inefficacy.

Friday, November 26, 2010

Is someone recording this?

This is what happens during a code:

Patient has a rhythm change, and one of us figures it out---they see it on the monitor, or they just watch their patient go quiet, and turn the color of faded violets. Unlike TV, there isn't blood everywhere...yet. There will be, but that's not for another four minutes or so. Also, there's generally not a physician present at the onset of arrest. So no, no Dr. Mark Greene calmly stating, "Okay, Code Blue". Nope. When someone's found down, the first, most visceral response is normally "oh SHIT IS THAT REAL?".

If it brings you any comfort, that's critical care speak for "Okay, Code Blue".

Suddenly, we swarm on Patient.
Everyone wants to help.
Everyone wants a piece.

Respiratory therapists, staff nurses, the house supervisor, the shift supervisor, the clerk, a couple of unit attendants, residents nervously gripping algorhythm cards, maybe an anesthesia provider or two, the attending physician all show up. Compressions, ambu bag, back board, pads, drugs, analysis of a rhythm, drugs, broken ribs, followed by attempts at art lines and central lines (this is where it gets bloody; it takes this long for someone to show the resident where the kits are) from the second someone finds Patient pulseless. If Patient is the lucky recipient of quality chest compressions, he's going to end up with at least a couple of broken ribs, which earns him a chest tube for pneumothorax management. Lightning Round: If Patient is having a particularly bad day, there might be a grand opening (cracking the chest right there in the patient's room). Wash, rinse, repeat for 15 minutes if you're following ACLS guidelines, or 30 minutes if your Code MD feels guilty about giving up.

First rule of Fight Club: Almost nobody survives ACLS.

I can't remember the last time anyone wore their safety goggles to one of these shindigs, for the record. Dr. Greene always had them on. No, no, no. 

Soundtrack to a Code: Hippie says he always hears "Sabotage". For me, it's Fear's "Coup D'Etat". Jimmy is too focused; no soundtrack, just a hell of a core workout during compressions. I don't know about the other nurses, though I should probably ask. Fun to compare notes, you know?