Bada Bing

By this point we all know how I feel about adult patients in general and the ICU in particular. (In brief: it is like having my soul sucked out through my toes) I had an experience yesterday that defies all words. I haven't even been able to file it under 'why adult medicine is interesting' or 'why adult medicine sucks.'

I was hanging in the ICU like normal yesterday afternoon working on ERAS application stuff (which we can submit on THURSDAY). Something aggravated me greatly (a whole 'nother story), so I decided to take a brief walk around the hospital. I left right as they were rolling a post-op patient up from the PACU (not pacu). I was gone for about twenty minutes, and when I came back in, I saw that everyone was clustered around the new patient's bed, which was relatively normal. Then I realized that there were TOO many people clustered there. And that some of the people were donning sterile gowns. And that one person was CRACKING HER CHEST. That's when I realized that something unusual was going on.

Turns out the patient's heart had stopped beating, and chest compressions weren't working, and she conveniently had a nice un-healed incision through her sternum, and bada-bing, bada-boom. Open heart surgery in the ICU.

The rest of the afternoon progressed in a similar fashion. Things just went crazy. I was actually happy to have stuff to do, even if a lot of it was just fetching and holding. (get me the chart! I need a suture removal kit!) I did get to do some procedure-ish stuff yesterday as well. I changed two lines over wire - which involves sticking a wire into a central line that is already inserted, pulling out the old line, sticking in a new one and stitching it down. I don't get to do the actual stick, which is generally the hardest part, but it is still a good chance to do something.

And during the open heart surgery, I got to squeeze in fluids. Which sounds like what it is. I squeezed a little plastic tube to make fluids go in faster.

In the end, it didn't matter. When you reach a point where you need your chest opened emergently, your chances of survival are minimal. We didn't beat the odds on this one.

I remember the first time a patient of mine died. I was horrified. I didn't write it down here, but I remember feeling that the world should stop to acknowledge the passing of a soul from this world. Even at that time, I knew that I'd have to accept death as a part of medical practice. I didn't realize that it would happen so quickly. Bada bing, bada boom: I'm 'professional.' I watched this person die yesterday, and what I'm left with is the coolness of seeing it all, and doing procedures, rather than the grief of losing a person.

I guess it is what we need to do to keep functioning on some level. I have yet to lose a pediatric patient, however. Somehow I feel that that will be different.