In the flow of the emergency room… and another dance with death…
Recently i was working in the emergency room, doing this wonderful job that i love so much and doing what i do best: serving people, helping them, relieving pain and suffering.
Every day is different but still, there is a certain routine in the emergency room. A stroke is a stroke. They all look the same and they are all treated the same. People differ, diagnosis do not. The work we do is like a dance, it’s like making music. Assess, investigate, diagnose, treat. Repeat. Assess, investigate, diagnose, treat. Repeat. There is a certain rythm to our daily work.
I love this work because i can help people.
I love this work because it gives me the privilege to work with great people.
That night started as a ordinary night. The routine dance of cases: chest pain, shortness of breath, hip fracture, pneumonia, etc… And i was flowing from one patient to the other. As i was finishing a chart, a nurse comes to me about this 35 year old screaming in pain, yelling, vomiting her heart out and she asks me to come see her right away. I prescribe a dose of morphine and gravol to relieve her symptoms and i ask that the nurse draw blood and urine to initiate an abdominal pain lab workup. And then i stop and think. Should i see this patient because she is screaming or should i follow the plan established by our triage guidelines? I look up at our patients flow software and i see something… There is an 83 yo man with back and abdominal pain waiting to be seen. We don’t hear him yelling. He’s fairly quiet. I don’t particulary like the quiet elderly in pain… So i decide to go see him. He is pale and diaphoretic. He describes a sudden sharp back pain radiating to the right flank. I think: could this be an triple A (AAA) or abdominal aortic aneurysm ? Baaahh probably not, i saw one last month and i usually see this once every 3-4 years. Well, let’s just make sure. I ask that the ultrasound machine be brought to the bedside while i assess the patient. Humm, it looks like renal colic but this could really be a triple A… I put the ultrasound probe on his belly and there it is again… Holy shit! Another one of these beast, my second encounter with this in 2016. The killer of killers, it’s a time bomb that want’s to explode in my patient belly. From now on, we are in a race against time. Do nothing and he dies, for sure. Stabilize him and get him to the operating room fast, he has a chance of surviving.
I breathe in and out. I calm down. Anxiety has no place in my line of work. I calmly say to my patient and his wife: I’m very sorry but i must tell you that i have found the cause of your pain you are suffering from an abdominal aortic aneurysm and it is dissecting. You need to undergo surgery as soon as possible. He understand immediatly and he says “Shiit”. I’ll call the vascular surgeon right away, transfer you to the resuscitation room and come back to explain more but there is no time to waste. Back at his bedside, i explain: a AAA is a very deadly disease. Your aorta is ballooning and it will explode if we don’t get you to surgery soon. I know that this is a stressfull time but i’m telling you, we can do this, we can survive this. I’ll be with you until you go to the operating room. I’ve seen this before and i’ve never lost one ( the survival rate is about 50% but i’m lucky…). Do you understand me? I look him in the eyes, we can do this. His wife is already crying. The vascular surgeon calls me back, he understand the urgency and he is on his way.
As we hook him on multiples large bore intravenous line and give him fluid, pain killers, etc… His blood pressure drops… (Fuck! this is not good.) I don’t say this but i think it. He looks bad. I asked for a crossmatch for blood. He looks at me and says: did i tell you that i’m taking Elliquis? What? You are taking Elliquis??? (Fuck shit, this is sooooo bad…)
OK, let’s explain… Elliquis is a blood thinner and there are no available antidotes to reverse it’s effect. A dissecting abdominal aortic aneurysm is like the biggest pipe conducting blood in your body and it’s leaking and it wants to burst open… What do you think this thing does on blood thinners? I am completely in my right mind when i say SHIIIT!
I could just give up and believe that he surely will die but i refuse.
I refuse to give up hope for my patient’s survival.
I keep my calm composure and i look at him in the eyes and i say: ” This will be a bumpy ride… but we can do this! Do you believe me?” He looks at me and says: “I’m afraid but yes, i believe you”.
The anesthesiologist calls me back. I tell him the bad new. This guy will bleed massively when we open him up so we decide to start the massive transfusion protocol right away. He is already in shock, bleeding out from a ruptured aneurysm, we must try and do everything we can to save his life. He probably has children and grand children. He’s just like your father or your grand father. We cannot quit. We cannot give up hope that he can survive this, even if his on blood thinners.
The surgeon arrives and quickly assess the patient. He is to be transfered STAT to the operating room. Before he leaves, i go to his bedside, i take his hand and i tell him: “It was a pleasure serving you, i’m giving you all the positive energy i can gather.” And i let him go. I go to his wife and i give her a big hug and i wish her good luck.
I let them go. I hope for the best. It is now out of my hand. I did my best. From our first handshake to saying good luck, 25 minutes have passed.
I breathe in, breathe out and go back to my flow, to my routine, to my work.
An hour later, i get a text message from the surgeon. Against all odds, our patient survived and is doing well. I smile. This is my simple reward.
Many thanks to the wonderful team of health workers that helped me tonight.
It is a real privilege to work with great people like you.
Thank you.
Original post Facebook, june 2016
Martin Pham Dinh 