Christmas Vacation 2006

This past Christmas we went on a 9 day bus trip down to Portland, LA, Vegas, and San Fran. It was an awesome trip and I got to see everything for the first time like Disneyland, Universal Studios, the Golden Gate Bridge and the strip in Vegas. Just the other day I was just recapping with Mark all the places that I have been to with him which include: Toronto, Quebec City, Montreal, London, Paris, Munich, Saltzburg, Vegas, LA, Portland, and San Fran. I look forward to traveling to many more new places with you Mark as each place we've gone to has left me with many memorable experiences and stories that we can both share in...

Lessons from the ER II

Yesterday was a crazy day in the Emerg. I got to assist with chest compressions (part of CPR - Cardiopulmonary Resuscitation) in a guy who had a cardiac arrest on the street. It all happened so quickly it was so surreal. It was a really sobering and humbling experience. In the end, we managed to get a heart rhythm back and he got sent to the ICU. I wonder how he's doing because he was transferred to a different hospital.....I wonder what happened to him...
I'm realizing that it's the moments afterwards when you reflect on the situation that most of the learning takes part - what went well, what didn't go to well....how I can improve on my knowledge of this and that. Looking back, I can remember landmarking and doing my compressions - just like we were taught at first aid. I kept looking at the ECG tracing and then his face, then the ECG tracing and then his face....hoping for a tracing on the heart monitor....hoping for a flicker of life. My body was tiring and I switched out of the chest compressions, and later he got a heart rhythm back. I was......we were all.....amazed.
A "Code Blue" really underlies the importance of teamwork, because there are so many small things that need to be done. Nurses, physicians, Resp therapists..and students....all working together in a co-ordinated manner for one sole purpose - to revive the patient. In this case, it worked, but I can imagine the countless other times that it doesn't work. It must be difficult to deal with those situations and the emotions that go with it. I wonder what it would feel like...

Lessons from the ER

Yesterday, I was amazed by two things: I admitted a 92 year old gentleman who came in with shortness of breath. After talking to him and his wife, getting a history and doing my physical exam, I concluded that his shortness of breath (SOB) was most likely due to his congestive heart failure: pulmonary edema due to left sided heart failure. During my physical exam, he didn't sound so bad. There were a few crackles and wheezes, but he wasn't sounding that bad. I presented the case to my attending, and we returned so that my attending could confirm what I found and give his assessment. Within....say, 30-45 minutes, the patient's condition had changed dramatically for the worse. His breathing was laboured, there were loud wheezes, his resp. rate was 34, and his oxygen saturation sats dropped to below 80% - all signs of respiratory distress. We diuresed him, gave him oxygen by mask and then started BIPAP (a breathing machine) to help improve ventilation, and within a few minutes, he started feeling better. Upon reflection, I am amazed at how quickly he decompensated - how he was stable when I saw him, but just a few minutes later, how bad he sounded. Makes me realize how important it is to keep a close eye on patients like this.
The more amazing lesson I learned, however, came from his wife. There she was at his bedside throughout the whole time. There she was holding his hand. There she was wiping sweat from his brow. There she was, encouraging him that things would be okay. And there she was, talking to me because he had difficulty with his words. Telling me that they had been married for 65 years, and through her actions, telling me that she would be loving him right to the end.