Tuesday, December 16, 2014

A Strangers Face

Today started like any other day. I got up, almost missed the bus, got to the hospital, put my white coat on, hung the stethoscope around my neck. Pretty run of the mill. I've been working in the Emergency Room in Poland since I got back a few weeks ago.

These are not patients from my hospital, the photo is from a newspaper.
It's one of the few North American type emergency rooms in my city. They usually get a trauma and severe medical issues. It's very different and yet very similar to the ED in the US. First off, it's organized different. They have a triage system, but I don't think they've quite got it down pat just yet. Second, the ED itself is small. I don't mean that to be rude or anything- it's a fact.  There are 8 beds jammed into a small room with a desk in the middle where the doctors take turns writing notes. Meanwhile there are at least 30 people waiting in the hallway to be seen (a HUGE difference from my last experience). The place just can't hold this many people and on top of that, there aren't enough staff.

But, just working in the emergency room was not the most defining part of my day. This was:

I was leaving the exam room after interviewing a patient with suspected MI and I noticed a man sitting in the hall waiting to be seen next. He was probably middle aged and he was quite skinny. I pointed him out to one of my classmates and I said, "There's a good example of the tripod position if you've never seen it." My classmate looked at him and remarked, "It looks like COPD."

We went to our next patient who was in the main room with all the beds and the desk. We started talking to our next patient and just as we were finishing up the history and exam one of the paramedics, the head doctor, and two of the nurses wheeled on a man on a gurney into the area right next to our patient. The doctor called us over.

He was blue. Proper blue. I think I realized at that moment that he wasn't going to make it. "Put on dee gloves!" our doctor yelled to us. (This was much louder than codes in the US). I put the gloves on. "You" he pointed to me, "Take over compressions after this cycle." I nodded and walked as confidently over to the side of the bed trying not to bump into the patient who I had just finished interviewing- there was a curtain, but it wasn't closed completely and curtains don't stop noise or increase space.

Two minutes was up, they checked the pulse, still none, they checked the rhythm, still a systole. "Continue compressions." I placed my hands on the mans bare chest like I'd been taught and began to press. It was easier than it had been on the mannequins, but that was most likely due to his small size. I got into a rhythm and then I made a huge mistake. I looked at his face.

It was as if the world stopped. All at once I felt faint and shaky. It was the man who I had pointed out to my classmate only moments before who had been sitting in the tripod position. His light brown eyes were still open, but his face was a shade of purple. I kept pressing.

Another 2 minutes passed. Still in asystole, still no pulse. Someone switched off with me. "How do you say 1,2,3 in Greek?" the head doctor asked on of my classmates standing nearby. We looked at him incredulously. A patient was dying and he wanted a Greek lesson? Other jokes were made which I couldn't understand- but laughter is a universal language.

Another 2 minutes. Still in a systole, still no pulse. I began compressions again. "Is it similar to a mannequin?" the doctor asked. "NO," I replied between compressions. "The mannequin doesn't look at me."

Another 2 minutes. Still in asystole, still no pulse, switch. Another 2 minutes, still in asystole, still no pulse, my turn again. I continued my compressions just as vigorously as before. A minute in I felt and heard a deafening snap as I broke at least two of his ribs. I stopped compressions for half a second, startled by the sensation.

 2 minutes, asystole,  no pulse, switch. 20 minutes passed like this. 2 minutes, asystole, no pulse, switch. 2 minutes, asystole.....

"Time of death: 20:58"

The other patients watched as they slowly began to disconnect him from the machines. They finally closed the curtain as they placed his body on another gurney and covered him with a sheet. The gurney with his body was taken out through the waiting room to the morgue. His right arm was still visible as they wheeled him away.

Once he was in cardiac arrest there probably wasn't much we could do. But, the fact that he was alive, sitting there, just 10 minutes before I began compressions on him... It's mind boggling. And even had he of been seen sooner, would we have realized quickly enough what was causing it before he went into asystole? Probably not.

All I know is, a man is dead and I will never forget his face.

Today started like any other day.

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