Monday, 23 August 2010

CPR and why I love my job.

Dr Jr has been feeling that his past few posts have been a bit gripey, so maybe it's time to put the shoe on the other foot and explain why he loves his job so much.

I've finished my weekend of nights and I'll tell ya, I haven't run around so much since I started training for a marathon (which I never actually entered, pffft). On the most, it was mainly prescribing fluids and warfarin where the day doctors had forgotten (or been too lazy...) to do. Patients also didn't seem to like having cannulas in either - another chunk of my time was replacing "lost" cannulas or trying to thread in cannulas where site practitioners had failed miserably and left me with a vein more equivalent to a loose thread of string than a large drainpipe.

But weekends have their upsides. For one, although being the only junior doc in the entire hospital, it gives you a lot more responsibility and forces you to make a lot more decisions by yourself. Of course, if there's anything you're unsure of, you can call your reg, but initial management is entirely down to you. A man decided that sleeping peacefully at night wasn't for him and decided to get severely short of breath. The poor guy was absolutely terrified and was begging for help between his gasps for breath. After listening to his chest and it sounding more like an off-key, underwater orchestra than a finely tuned organ for efficient gas transfer, I popped him on salbutamol nebs, stopped his fluids and gave a stat dose of frusemide (sounds much better than furosemide doesn't it?) to pull the fluid out of his chest. 15-20 minutes later, he was calming down and the difference in his breathing was staggering. Within the hour, he was peacefully asleep. Having a little touch of extra responsibility and seeing your decisions make a proper difference really fills you with "feel-good". But that pales in comparison to what happened later.
If only the person who made this really knew...

I had my first crash call this weekend. While keeping some poor lady up at 3am in the morning trying to take some blood to get gentamycin levels that the day docs had forgotten to do, the siren call of my attached "blue baby" (what I've started calling my bleep. Small, noisy, demanding and never satisfied, just like babies, and in a "cute" (bleurgh) shade of what can only be described as baby blue) shouts out "Crash call, X Ward!". Apologising profusely, I take the needle out of the patient (who's had three different people poking her with needles for the last 2 hours to try and get some blood) and sprint across the hospital and up two flights of stairs, passing the AAU SHO who is ambling at a rather leisurely pace.

When I get there, I see I'm the first doc. The nurses have just started CPR and are looking expectantly at the sweating and smelly Dr Jr. It's at these points that you realise you have several metres of detrius in your brain covering the bit of knowledge you need to save this woman's life. After spending a few milliseconds waving away the hazy recollections of that party the night after Dr Jr learnt his advanced life support, your brain engages. I took over CPR, asked the nurses to get the defibrillator and attach the leads so we could get a heart tracing. I asked another nurse to get the adrenaline and amiodarone ready incase we needed it down the line.

Now what Joe Public don't understand is that CPR is rarely successful. On Casualty, ER and the like, you get the impression that someone slides your hands across your chest rather pathetically and a minute later, you're up and chatting, throwing roses and thank you cards at your new-found-hero. The reality is a bit more gruesome. For a start, the success rate is tiny and of those people who go into arrest, only 5% ever leave hospital again. On top of that, you generally end up breaking every rib in someone's body, at least if you're doing it right. The feeling is horrible.

Then there's the "shock". For a start, only a very small number of cases are "shockable". Cardiac arrest can be any one of four heart rhythms, of which only two are shockable. Can't remember which TV program I saw recently that someone in asystole was shocked and came around. No wonder public expectations are high.

In any case, by the time we got a rhythm readout, my reg and the SHO had made their way up and took command. I just carried on chest compressions. Lo and behold, a minute later, the patient's eyes open with a start and she starts moaning. She's alive.

The feeling of satisfaction for doing something like that is simply indescribable. It's at points like these you forget the horrendous hours, the frothing-at-the-mouth consultant biochemists, the smell of various bodily fluids everywhere you go, the patients who try to punch you, the constant wandering around like a zombie trying to find somewhere to sleep and every trial and tribulation you go through on a daily basis and remember:

"I'm a doctor and I can make a difference."

And at that point, you realise that you love this job and couldn't do anything else.


hippocrazy...son of hippocrates said...

oh yes, quite inspirational indeed!

The Shrink said...

Some orthopaedic teams views differ from yours ;-)

Dr Jr said...

Aha! That's hilarious!