Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER by Pamela Grim
Authors: Pamela Grim
Tags: BIO017000
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pride there. You can't help thinking what you are thinking, which is,
I did this.
Then you think aloud, “I should check the x-ray.”
It's up on the light box. You amble over and look up at it, squinting. You look first for the endotracheal tube, which has a little radiopaque stripe. It is well above the corina, the bifurcation point of the trachea. You look at the lungs and a casual glance at what's next, the ribs, the stomach. No mysteries revealed.
“We need a copy of this x-ray,” you say, still looking up at it. Marveling at it. “To go with the kid.”
The clerk from in front shouts back, “I gotta Doctor Hu or Hue or something, on the phone. He wants to hear about the patient.” Simultaneously Helen says, “The heart rate is dropping.”
You pick up the phone on the wall and have a distracted four-minute conversation with a doctor who speaks almost incomprehensible English and doesn't seem to understand you any more than you understand him. Meanwhile you stand there, staring across at the monitor. The heart rate drops as you watch. Once 150, it is now 130.
The unit secretary steps into the room with the results of the cord blood gas. You look down at them, frowning, but the results are really pretty good. The baby is acidotic—a touch on the acidic side—not too surprising, considering the nature of the delivery. The electrolytes, sodium, potassium, etc., are all okay. In short, nothing that needs correcting right now.
You look back up at the monitor, which now gives a heart rate of 120. You look at the baby, and maybe this is just your hyperstimulated imagination, but the baby looks a little bluer again. As you stand there in front of the monitor, you watch the heart rate drop: 120…119…117…114. The baby is more restless as well, little hands raised in the air, fingers reaching out, folding, then reaching once more.
113…110…108…
This is not your imagination.
But still you stand there, lead-footed, gazing up at the monitor, your jaw slack, mouth dry, glancing occasionally down at the baby only to look immediately back up at the monitor, hoping. You unloop your stethoscope and start from the beginning, listening to heart sounds, lung sounds. You recheck the endotracheal tube—it could easily have slipped out of place, but no, the lung sounds are okay. The heart sounds a little more distant maybe—maybe—not sure. Could be. For sure, though, the hands are mottled, blue, frankly blue, almost vermilion, cyanotic.
“We should check another sugar,” you say, uncertainly. “Get a new set of electrolytes,” but you are thinking, No this cannot be. We brought this baby back. The baby was looking good.
105…104…102.
…99…98.
“What's wrong?” Helen wants to know. “What's happening? Why is his pulse rate dropping?”
“Is my baby all right?” the mother calls from her gurney. “My baby…”
You say nothing but lean over, plant your hands on the mat on either side of the baby and stare down at him. The baby looks slightly shriveled and much bluer for sure now. You prod the chest with a finger. The child stirs, arms waving still but more feebly.
97…94…
Your head hurts. It more than hurts, it feels as if someone took a hammer to the back of your skull, and a screwdriver to pry out each eye. You suddenly realize how tired you are—it's almost four A.M. now—and how ill-prepared you really are to be here. Six hours ago you thought you were on the top of the medical heap, at the peak of medical conditioning. Now you see your future as a long road of disasters striped with dense shadows of ignorance. You see the heart attack patient who goes sour, septic patients, asthmatic patients. All little catastrophes out there just waiting for you, and maybe you just won't know what to do.
“What is going on?” the mother asks. “Can I hold my baby?”
You ignore her.
“Excuse me, but it is my baby. I do have a right to hold it.”
Still, everyone ignores her. You continue to
I did this.
Then you think aloud, “I should check the x-ray.”
It's up on the light box. You amble over and look up at it, squinting. You look first for the endotracheal tube, which has a little radiopaque stripe. It is well above the corina, the bifurcation point of the trachea. You look at the lungs and a casual glance at what's next, the ribs, the stomach. No mysteries revealed.
“We need a copy of this x-ray,” you say, still looking up at it. Marveling at it. “To go with the kid.”
The clerk from in front shouts back, “I gotta Doctor Hu or Hue or something, on the phone. He wants to hear about the patient.” Simultaneously Helen says, “The heart rate is dropping.”
You pick up the phone on the wall and have a distracted four-minute conversation with a doctor who speaks almost incomprehensible English and doesn't seem to understand you any more than you understand him. Meanwhile you stand there, staring across at the monitor. The heart rate drops as you watch. Once 150, it is now 130.
The unit secretary steps into the room with the results of the cord blood gas. You look down at them, frowning, but the results are really pretty good. The baby is acidotic—a touch on the acidic side—not too surprising, considering the nature of the delivery. The electrolytes, sodium, potassium, etc., are all okay. In short, nothing that needs correcting right now.
You look back up at the monitor, which now gives a heart rate of 120. You look at the baby, and maybe this is just your hyperstimulated imagination, but the baby looks a little bluer again. As you stand there in front of the monitor, you watch the heart rate drop: 120…119…117…114. The baby is more restless as well, little hands raised in the air, fingers reaching out, folding, then reaching once more.
113…110…108…
This is not your imagination.
But still you stand there, lead-footed, gazing up at the monitor, your jaw slack, mouth dry, glancing occasionally down at the baby only to look immediately back up at the monitor, hoping. You unloop your stethoscope and start from the beginning, listening to heart sounds, lung sounds. You recheck the endotracheal tube—it could easily have slipped out of place, but no, the lung sounds are okay. The heart sounds a little more distant maybe—maybe—not sure. Could be. For sure, though, the hands are mottled, blue, frankly blue, almost vermilion, cyanotic.
“We should check another sugar,” you say, uncertainly. “Get a new set of electrolytes,” but you are thinking, No this cannot be. We brought this baby back. The baby was looking good.
105…104…102.
…99…98.
“What's wrong?” Helen wants to know. “What's happening? Why is his pulse rate dropping?”
“Is my baby all right?” the mother calls from her gurney. “My baby…”
You say nothing but lean over, plant your hands on the mat on either side of the baby and stare down at him. The baby looks slightly shriveled and much bluer for sure now. You prod the chest with a finger. The child stirs, arms waving still but more feebly.
97…94…
Your head hurts. It more than hurts, it feels as if someone took a hammer to the back of your skull, and a screwdriver to pry out each eye. You suddenly realize how tired you are—it's almost four A.M. now—and how ill-prepared you really are to be here. Six hours ago you thought you were on the top of the medical heap, at the peak of medical conditioning. Now you see your future as a long road of disasters striped with dense shadows of ignorance. You see the heart attack patient who goes sour, septic patients, asthmatic patients. All little catastrophes out there just waiting for you, and maybe you just won't know what to do.
“What is going on?” the mother asks. “Can I hold my baby?”
You ignore her.
“Excuse me, but it is my baby. I do have a right to hold it.”
Still, everyone ignores her. You continue to
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